Provider Demographics
NPI:1437045663
Name:ESPINOZA SUAREZ, TUPAC MALLCU (SA-C)
Entity type:Individual
Prefix:
First Name:TUPAC
Middle Name:MALLCU
Last Name:ESPINOZA SUAREZ
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15630 SW 80TH ST APT I-108
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-3336
Mailing Address - Country:US
Mailing Address - Phone:813-785-2741
Mailing Address - Fax:
Practice Address - Street 1:15630 SW 80TH ST APT I-108
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-3336
Practice Address - Country:US
Practice Address - Phone:813-785-2741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25-288246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant