Healthcare Provider Details

I. General information

NPI: 1477963262
Provider Name (Legal Business Name): JENIFER CUESTAS M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2014
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 W MILLER ST
ORLANDO FL
32806-2009
US

IV. Provider business mailing address

670 NW 114TH AVE APT 202
MIAMI FL
33172-4720
US

V. Phone/Fax

Practice location:
  • Phone: 305-338-2503
  • Fax:
Mailing address:
  • Phone: 305-338-2503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberME144746
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: