Healthcare Provider Details

I. General information

NPI: 1467829895
Provider Name (Legal Business Name): GISELLE ENID CUADRADO MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 09/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

A9 URB SAN ANTONIO SUITE B
HUMACAO PR
00791
US

IV. Provider business mailing address

PO BOX 8802
HUMACAO PR
00792
US

V. Phone/Fax

Practice location:
  • Phone: 787-479-3811
  • Fax:
Mailing address:
  • Phone: 787-479-3811
  • Fax: 787-465-0616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6820
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: