Healthcare Provider Details

I. General information

NPI: 1306289400
Provider Name (Legal Business Name): VICTOR CUEVAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 04/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 NW 107TH AVE SUITE 109
SWEETWATER FL
33172-2732
US

IV. Provider business mailing address

1414 NW 107TH AVE SUITE 109
SWEETWATER FL
33172-2732
US

V. Phone/Fax

Practice location:
  • Phone: 786-762-2952
  • Fax:
Mailing address:
  • Phone: 786-762-2952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH 14704
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: