Healthcare Provider Details

I. General information

NPI: 1023300126
Provider Name (Legal Business Name): DANIEL CUETO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2011
Last Update Date: 11/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21297 OLEAN BLVD STE A
PORT CHARLOTTE FL
33952-6704
US

IV. Provider business mailing address

2675 WINKLER AVE FL 2
FORT MYERS FL
33901-9342
US

V. Phone/Fax

Practice location:
  • Phone: 855-979-5700
  • Fax:
Mailing address:
  • Phone: 877-856-3774
  • Fax: 239-599-2625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME109108
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: