Healthcare Provider Details

I. General information

NPI: 1790294502
Provider Name (Legal Business Name): ERIT ENMANUEL CUEVAS FELIZ SA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6471 COW PEN ROAD APT 210
MIAMI LAKES FL
33014
US

IV. Provider business mailing address

6471 COW PEN RD APT 210
MIAMI LAKES FL
33014-7609
US

V. Phone/Fax

Practice location:
  • Phone: 786-393-3119
  • Fax:
Mailing address:
  • Phone: 786-393-3119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number17-476
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: