Provider Demographics
NPI:1992544241
Name:SUAREZ ALBIS, CRYSTHIAN BRAYAN
Entity type:Individual
Prefix:
First Name:CRYSTHIAN
Middle Name:BRAYAN
Last Name:SUAREZ ALBIS
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 1:20710 SW 105TH AVE
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-3634
Mailing Address - Country:US
Mailing Address - Phone:305-440-8075
Mailing Address - Fax:
Practice Address - Street 1:20710 SW 105TH AVE
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-3634
Practice Address - Country:US
Practice Address - Phone:305-440-8075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-348050106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician