Healthcare Provider Details

I. General information

NPI: 1124024047
Provider Name (Legal Business Name): GUILLERMO B CUNA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 CLAYTON CT
FORT MYERS FL
33907
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-8240
  • Fax: 239-343-8241
Mailing address:
  • Phone: 239-343-8240
  • Fax: 239-343-8241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0059846
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number109076
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: