Healthcare Provider Details

I. General information

NPI: 1942717103
Provider Name (Legal Business Name): HEISY CUELLAR DE LA TORRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6732 LONE OAK BLVD
NAPLES FL
34109-6834
US

IV. Provider business mailing address

3780 8TH AVE NE
NAPLES FL
34120-4923
US

V. Phone/Fax

Practice location:
  • Phone: 239-351-0675
  • Fax: 239-631-5295
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: