Healthcare Provider Details

I. General information

NPI: 1649169236
Provider Name (Legal Business Name): FERNANDO A CUEVAS QUINTANA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/30/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 4020 KM 2.0 BO CORCOVADA
ANASCO PR
00610
US

IV. Provider business mailing address

CARR 4020 KM 2.0 BO CORCOVADA
ANASCO PR
00610
US

V. Phone/Fax

Practice location:
  • Phone: 939-865-1519
  • Fax:
Mailing address:
  • Phone: 939-865-1519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15787
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: