Healthcare Provider Details

I. General information

NPI: 1043045966
Provider Name (Legal Business Name): SELINA F CUEVAS CAP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 09/03/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12700 W DIXIE HWY
NORTH MIAMI FL
33161-4806
US

IV. Provider business mailing address

1705 NE 178TH ST
NORTH MIAMI BEACH FL
33162-1513
US

V. Phone/Fax

Practice location:
  • Phone: 786-329-4600
  • Fax:
Mailing address:
  • Phone: 305-337-0570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: