Provider Demographics
NPI:1730762584
Name:SUAREZ, STEFAN RIGOROSO (LMT)
Entity type:Individual
Prefix:
First Name:STEFAN
Middle Name:RIGOROSO
Last Name:SUAREZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318A MCDONOUGH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-2144
Mailing Address - Country:US
Mailing Address - Phone:757-515-4375
Mailing Address - Fax:
Practice Address - Street 1:3536 GROVE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23221-2200
Practice Address - Country:US
Practice Address - Phone:804-616-3946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019017182225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist