Provider Demographics
NPI:1306931217
Name:SUAREZ ROSADO, CARMEN (AUD)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:SUAREZ ROSADO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1808
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737
Mailing Address - Country:US
Mailing Address - Phone:787-792-0760
Mailing Address - Fax:787-792-0635
Practice Address - Street 1:1627 AVE JESUS T PINERO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-5407
Practice Address - Country:US
Practice Address - Phone:787-792-0760
Practice Address - Fax:787-792-0635
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2355A2700X
PR000532231HA2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
No2355A2700XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistAudiology Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5-7317Medicare ID - Type UnspecifiedAUDIOLOGIST