Healthcare Provider Details

I. General information

NPI: 1073581799
Provider Name (Legal Business Name): RAMON LUIS CUEVAS-TRISAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7305 N MILITARY TRL PM&RS (117)
RIVIERA BEACH FL
33410-7417
US

IV. Provider business mailing address

166 VIA CONDADO WAY
PALM BEACH GARDENS FL
33418-1700
US

V. Phone/Fax

Practice location:
  • Phone: 561-422-5732
  • Fax: 561-422-8288
Mailing address:
  • Phone: 561-422-5732
  • Fax: 561-422-8288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME71375
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: