Healthcare Provider Details

I. General information

NPI: 1881895951
Provider Name (Legal Business Name): ANTONIO MIGUEL CUBANO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

352 ENGLENOOK DR
DEBARY FL
32713-1803
US

IV. Provider business mailing address

352 ENGLENOOK DR
DEBARY FL
32713-1803
US

V. Phone/Fax

Practice location:
  • Phone: 407-732-7266
  • Fax: 407-732-7310
Mailing address:
  • Phone: 407-732-7266
  • Fax: 407-732-7310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME101147
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: