Healthcare Provider Details

I. General information

NPI: 1932168762
Provider Name (Legal Business Name): HARRY R CUEVAS BOCANEGRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 S SEMORAN BLVD
ORLANDO FL
32822-2469
US

IV. Provider business mailing address

4445 S SEMORAN BLVD
ORLANDO FL
32822-2469
US

V. Phone/Fax

Practice location:
  • Phone: 407-203-8957
  • Fax: 855-296-8047
Mailing address:
  • Phone: 407-203-8957
  • Fax: 855-296-8047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberACN530
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number9694
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberACN530
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: