Healthcare Provider Details

I. General information

NPI: 1851686794
Provider Name (Legal Business Name): MARTHA PATRICIA CUADRO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2011
Last Update Date: 06/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 EMMETT ST
KISSIMMEE FL
34741-5548
US

IV. Provider business mailing address

PO BOX 452878
KISSIMMEE FL
34744
US

V. Phone/Fax

Practice location:
  • Phone: 407-575-4636
  • Fax: 321-250-7425
Mailing address:
  • Phone: 407-575-4636
  • Fax: 321-250-7425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: