Provider Demographics
NPI:1982719787
Name:SUASNAVAR, ENIO R (MD)
Entity type:Individual
Prefix:DR
First Name:ENIO
Middle Name:R
Last Name:SUASNAVAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:D27 CALLE 8
Mailing Address - Street 2:PASEO MAYOR
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4697
Mailing Address - Country:US
Mailing Address - Phone:787-755-5105
Mailing Address - Fax:787-761-2944
Practice Address - Street 1:D27 CALLE 8
Practice Address - Street 2:PASEO MAYOR
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-4697
Practice Address - Country:US
Practice Address - Phone:787-755-5105
Practice Address - Fax:787-761-2944
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8094208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR8094OtherMEDICAL LICENSE
PR8094OtherMEDICAL LICENSE
PRC82720Medicare UPIN