Provider Demographics
NPI:1730996448
Name:FUENTES SUAREZ, DEVORAH
Entity type:Individual
Prefix:
First Name:DEVORAH
Middle Name:
Last Name:FUENTES SUAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5265 W 24TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-4802
Mailing Address - Country:US
Mailing Address - Phone:786-258-5973
Mailing Address - Fax:
Practice Address - Street 1:1840 W 49TH ST STE 302
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2965
Practice Address - Country:US
Practice Address - Phone:786-258-5973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty