Provider Demographics
NPI:1053905653
Name:HORTA SUAREZ, ANDREA M (OD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:HORTA SUAREZ
Suffix:
Gender:F
Credentials:OD
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:360 CALLE DEL PARQUE
Mailing Address - Street 2:STE 1 CIUDADELA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00912-3717
Mailing Address - Country:US
Mailing Address - Phone:787-919-3156
Mailing Address - Fax:787-945-5078
Practice Address - Street 1:360 CALLE DEL PARQUE
Practice Address - Street 2:STE 1 CIUDADELA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00912-3717
Practice Address - Country:US
Practice Address - Phone:787-919-3156
Practice Address - Fax:787-945-5078
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-24
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX10150T152W00000X
PR749-450152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist