Healthcare Provider Details

I. General information

NPI: 1073563425
Provider Name (Legal Business Name): RICHARD CUELLO FUENTES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3185 SW 8TH ST
MIAMI FL
33135-4533
US

IV. Provider business mailing address

3185 SW 8TH ST
MIAMI FL
33135-4533
US

V. Phone/Fax

Practice location:
  • Phone: 305-532-8355
  • Fax: 305-532-9675
Mailing address:
  • Phone: 305-859-7719
  • Fax: 305-859-7839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME80624
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: