Healthcare Provider Details

I. General information

NPI: 1558107086
Provider Name (Legal Business Name): ELVIN JOSE CUEVAS RRA (ARRT)
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2024
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 UNDERWOOD ST
ORLANDO FL
32806-1110
US

IV. Provider business mailing address

52 UNDERWOOD ST
ORLANDO FL
32806-1110
US

V. Phone/Fax

Practice location:
  • Phone: 321-842-8475
  • Fax: 407-849-6470
Mailing address:
  • Phone: 321-842-8475
  • Fax: 407-849-6470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code243U00000X
TaxonomyRadiology Practitioner Assistant
License NumberRA115
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number403249
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: