Healthcare Provider Details

I. General information

NPI: 1215065214
Provider Name (Legal Business Name): MRS. EVELYN M CUEVAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 NW 14TH AVE
MIAMI FL
33125-1616
US

IV. Provider business mailing address

14863 SW 179TH ST
MIAMI FL
33187-7711
US

V. Phone/Fax

Practice location:
  • Phone: 305-325-1080
  • Fax: 305-325-1044
Mailing address:
  • Phone: 305-233-6706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: