Healthcare Provider Details

I. General information

NPI: 1568003150
Provider Name (Legal Business Name): EVELYN CUEVAS DE DE LA CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2019
Last Update Date: 10/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5625 S UNIVERSITY DR
DAVIE FL
33328-6100
US

IV. Provider business mailing address

5625 S UNIVERSITY DR
DAVIE FL
33328-6100
US

V. Phone/Fax

Practice location:
  • Phone: 954-893-9499
  • Fax: 954-893-9455
Mailing address:
  • Phone: 954-893-9499
  • Fax: 954-893-9455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: