Provider Demographics
NPI:1104343565
Name:SUAREZ ALVAREZ, AINNA
Entity type:Individual
Prefix:
First Name:AINNA
Middle Name:
Last Name:SUAREZ ALVAREZ
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 1:4212 SW 49TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-5610
Mailing Address - Country:US
Mailing Address - Phone:954-707-8151
Mailing Address - Fax:
Practice Address - Street 1:4212 SW 49TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33314-5610
Practice Address - Country:US
Practice Address - Phone:954-707-8151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty