Healthcare Provider Details

I. General information

NPI: 1912720764
Provider Name (Legal Business Name): MRS. MARLENE DE LA CARIDAD CUETO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2024
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 NW 29TH ST
MIAMI FL
33142-6623
US

IV. Provider business mailing address

1501 NW 29TH ST
MIAMI FL
33142-6623
US

V. Phone/Fax

Practice location:
  • Phone: 305-599-3021
  • Fax: 305-599-3033
Mailing address:
  • Phone: 305-599-3021
  • Fax: 305-599-3033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI7522
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: