Healthcare Provider Details

I. General information

NPI: 1053603159
Provider Name (Legal Business Name): MRS. NILSA TERESA CUEVAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2011
Last Update Date: 05/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 2 BOX 6269
LARES PR
00669-9762
US

IV. Provider business mailing address

HC 2 BOX 6269
LARES PR
00669-9762
US

V. Phone/Fax

Practice location:
  • Phone: 787-503-9848
  • Fax:
Mailing address:
  • Phone: 787-503-9848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2245
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: