Healthcare Provider Details

I. General information

NPI: 1629684204
Provider Name (Legal Business Name): KAROLYNA N CUESTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2020
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 W BROWARD BLVD STE I
PLANTATION FL
33317-3753
US

IV. Provider business mailing address

1501 NW 108TH AVE APT 323
PLANTATION FL
33322-6905
US

V. Phone/Fax

Practice location:
  • Phone: 561-774-8225
  • Fax:
Mailing address:
  • Phone: 754-281-3766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: