Healthcare Provider Details

I. General information

NPI: 1710148499
Provider Name (Legal Business Name): ADOLFO ALFREDO CUELI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 05/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 BAPTIST WAY
HOMESTEAD FL
33033-7600
US

IV. Provider business mailing address

10425 SW 62ND ST
MIAMI FL
33173-2818
US

V. Phone/Fax

Practice location:
  • Phone: 305-270-4699
  • Fax: 786-243-8074
Mailing address:
  • Phone: 786-243-8073
  • Fax: 786-243-8074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME109364
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: