Healthcare Provider Details

I. General information

NPI: 1225865033
Provider Name (Legal Business Name): MISS BRENDA LIZ CUEVAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 09/16/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PR 14 KM 4.2 BO. MACHUELO
PONCE PR
00717
US

IV. Provider business mailing address

HC 2 BOX 6968
ADJUNTAS PR
00601-9668
US

V. Phone/Fax

Practice location:
  • Phone: 787-844-0101
  • Fax:
Mailing address:
  • Phone: 787-223-8162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16750
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: