Provider Demographics
NPI:1194294298
Name:SUAREZ GIL, JEISELA
Entity type:Individual
Prefix:
First Name:JEISELA
Middle Name:
Last Name:SUAREZ GIL
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JEISELA
Other - Middle Name:
Other - Last Name:SUAREZ GIL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1716
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-1716
Mailing Address - Country:US
Mailing Address - Phone:787-372-4383
Mailing Address - Fax:
Practice Address - Street 1:BARRIADA SAN LUIS
Practice Address - Street 2:CALLE NAZARRET #19
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705
Practice Address - Country:US
Practice Address - Phone:787-372-4383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR04050103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling