Healthcare Provider Details

I. General information

NPI: 1710006580
Provider Name (Legal Business Name): MARISOL CUEVAS OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE ROBERTO CLEMENTE BLK 27-16 VILLA CAROLINA
CAROLINA PR
00985
US

IV. Provider business mailing address

PO BOX 2963
CAROLINA PR
00984-2963
US

V. Phone/Fax

Practice location:
  • Phone: 787-276-8123
  • Fax: 787-276-8123
Mailing address:
  • Phone: 787-398-4921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number576
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: