Provider Demographics
NPI:1487778908
Name:GONZALEZ-SUAREZ, CARLOS PEDRO (MD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:PEDRO
Last Name:GONZALEZ-SUAREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 SAN REMO AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-3043
Mailing Address - Country:US
Mailing Address - Phone:305-669-6800
Mailing Address - Fax:305-669-0737
Practice Address - Street 1:1500 SAN REMO AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-3043
Practice Address - Country:US
Practice Address - Phone:305-669-6800
Practice Address - Fax:305-669-0737
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00387172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063753Medicare UPIN
FL00096154Medicare ID - Type Unspecified