Healthcare Provider Details

I. General information

NPI: 1306862743
Provider Name (Legal Business Name): ANGEL L CUESTA I DPM, FACFAS, PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 04/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6831 NW 11TH PL STE 3
GAINESVILLE FL
32605-4259
US

IV. Provider business mailing address

6831 NW 11TH PL SUITE #3
GAINESVILLE FL
32605-4259
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-3077
  • Fax: 352-331-3265
Mailing address:
  • Phone: 352-331-3077
  • Fax: 352-331-3265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO2016
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: