Healthcare Provider Details

I. General information

NPI: 1831524958
Provider Name (Legal Business Name): YOSMANY CUELLAR DUQUE MT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2013
Last Update Date: 09/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 W LAMBRIGHT ST SUITE 104
TAMPA FL
33614-4750
US

IV. Provider business mailing address

3430 W LAMBRIGHT ST SUITE 104
TAMPA FL
33614-4750
US

V. Phone/Fax

Practice location:
  • Phone: 813-872-7209
  • Fax: 813-872-7207
Mailing address:
  • Phone: 813-872-7209
  • Fax: 813-872-7207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA73489
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: