Provider Demographics
NPI:1215708862
Name:SUAREZ, KIMBERLY TAMARA
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:TAMARA
Last Name: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 1:5949 LAKE CREST WAY APT 48
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-3356
Mailing Address - Country:US
Mailing Address - Phone:510-706-9060
Mailing Address - Fax:
Practice Address - Street 1:5949 LAKE CREST WAY APT 48
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95822-3356
Practice Address - Country:US
Practice Address - Phone:510-706-9060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst