Provider Demographics
NPI:1144521014
Name:SUAREZ, ODALIS (MA)
Entity type:Individual
Prefix:
First Name:ODALIS
Middle Name:
Last Name:SUAREZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 SE 6TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-5354
Mailing Address - Country:US
Mailing Address - Phone:786-879-6198
Mailing Address - Fax:
Practice Address - Street 1:737 E 10TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-3635
Practice Address - Country:US
Practice Address - Phone:305-888-7378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRMA133904172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker