Provider Demographics
NPI:1972214278
Name:SUAREZ SOTOMAYOR, CAMILO
Entity type:Individual
Prefix:
First Name:CAMILO
Middle Name:
Last Name:SUAREZ SOTOMAYOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4405 LA REINA CIR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-5101
Mailing Address - Country:US
Mailing Address - Phone:702-931-0735
Mailing Address - Fax:
Practice Address - Street 1:4405 LA REINA CIR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-5101
Practice Address - Country:US
Practice Address - Phone:702-931-0735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health