Healthcare Provider Details

I. General information

NPI: 1982313268
Provider Name (Legal Business Name): GENESIS Y CUEVAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2022
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6250 HAZELTINE NATIONAL DR STE 102
ORLANDO FL
32822-5102
US

IV. Provider business mailing address

6250 HAZELTINE NATIONAL DR STE 102
ORLANDO FL
32822-5102
US

V. Phone/Fax

Practice location:
  • Phone: 407-237-9955
  • Fax: 833-792-1182
Mailing address:
  • Phone: 407-237-9955
  • Fax: 833-792-1182

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: