Healthcare Provider Details

I. General information

NPI: 1922464528
Provider Name (Legal Business Name): MICHEL ERNESTO CUETO CANABATE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2016
Last Update Date: 01/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18000 NW 68 AVE APT 417
HIALEAH FL
33015
US

IV. Provider business mailing address

18000 NW 68 AVE APT 417
HIALEAH FL
33015
US

V. Phone/Fax

Practice location:
  • Phone: 786-768-6690
  • Fax:
Mailing address:
  • Phone: 786-768-6690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number15-761
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: