Healthcare Provider Details

I. General information

NPI: 1790897304
Provider Name (Legal Business Name): GUSTAVO J CUADRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2329 SUNSET POINT RD SUITE 203
CLEARWATER FL
33765-1455
US

IV. Provider business mailing address

2329 SUNSET POINT RD SUITE 203
CLEARWATER FL
33765-1455
US

V. Phone/Fax

Practice location:
  • Phone: 727-446-7756
  • Fax: 727-446-5977
Mailing address:
  • Phone: 727-446-7756
  • Fax: 727-446-5977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME83167
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: