Healthcare Provider Details

I. General information

NPI: 1962183665
Provider Name (Legal Business Name): ANGEL MANUEL CUENCA GONGORA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ANGEL M CUENCA MD

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 02/11/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 W OAK ST
KISSIMMEE FL
34741-6627
US

IV. Provider business mailing address

6675 WESTWOOD BLVD STE 475
ORLANDO FL
32821-6027
US

V. Phone/Fax

Practice location:
  • Phone: 407-750-6980
  • Fax:
Mailing address:
  • Phone: 407-845-0330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number24217
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1691
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: