Healthcare Provider Details

I. General information

NPI: 1336553981
Provider Name (Legal Business Name): VERONICA CUALA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VERONICA CUALA PABLO LEONARDO NURSE

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 06/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55-16 JUNCTION BLVD.
ELMHURST NY
11373
US

IV. Provider business mailing address

55-16 JUNCTION BLVD.
ELMHURST NY
11373
US

V. Phone/Fax

Practice location:
  • Phone: 917-714-8668
  • Fax:
Mailing address:
  • Phone: 917-714-8668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number423104-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: