Healthcare Provider Details

I. General information

NPI: 1013662212
Provider Name (Legal Business Name): DEILY CUEVAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2022
Last Update Date: 02/17/2022
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10854 SW 224TH TER
MIAMI FL
33170-6511
US

IV. Provider business mailing address

10854 SW 224TH TER
MIAMI FL
33170-6511
US

V. Phone/Fax

Practice location:
  • Phone: 786-357-8722
  • Fax:
Mailing address:
  • Phone: 786-357-8722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number20122359
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: