Healthcare Provider Details

I. General information

NPI: 1750932042
Provider Name (Legal Business Name): NAIROBIS CUEVAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2019
Last Update Date: 09/28/2021
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4031 PARK AVE BRONX NY
NEW YORK NY
10457-2913
US

IV. Provider business mailing address

307 W 38TH ST
NEW YORK NY
10018-2913
US

V. Phone/Fax

Practice location:
  • Phone: 347-705-2198
  • Fax:
Mailing address:
  • Phone: 212-695-4564
  • Fax: 845-735-3594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: