Healthcare Provider Details

I. General information

NPI: 1053181883
Provider Name (Legal Business Name): FERNANDO CUEVAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2024
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 TEQUILA TRL
DELTONA FL
32725-8551
US

IV. Provider business mailing address

420 TEQUILA TRL
DELTONA FL
32725-8551
US

V. Phone/Fax

Practice location:
  • Phone: 386-675-2252
  • Fax:
Mailing address:
  • Phone: 386-675-2252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-318108
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: