Healthcare Provider Details

I. General information

NPI: 1912192113
Provider Name (Legal Business Name): ANGEL L CUESTA DPM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 05/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6831 NW 11TH PL SUITE 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: 352-331-3077
Mailing address:
  • Phone: 352-331-3077
  • Fax: 352-331-3077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ANGEL LEANDRO CUESTA
Title or Position: PRESIDENT
Credential: DPM
Phone: 352-331-3077