Healthcare Provider Details

I. General information

NPI: 1972491033
Provider Name (Legal Business Name): MR. JEAN CARLOS CUEVAS DIAZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 06/26/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

E24 CALLE ROMA
GUAYNABO PR
00966-1724
US

IV. Provider business mailing address

E24 CALLE ROMA
GUAYNABO PR
00966-1724
US

V. Phone/Fax

Practice location:
  • Phone: 787-719-0367
  • Fax:
Mailing address:
  • Phone: 787-719-0367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number26834
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: