Healthcare Provider Details

I. General information

NPI: 1841230554
Provider Name (Legal Business Name): MANUEL CUBERO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA #3 ESQUINA BARBOSA #2 BARRIO COQUI AGUIRRE
SALINAS PR
00704
US

IV. Provider business mailing address

PO BOX 1499
GUAYAMA PR
00785-1499
US

V. Phone/Fax

Practice location:
  • Phone: 787-853-2410
  • Fax: 787-853-0463
Mailing address:
  • Phone: 787-263-1277
  • Fax: 787-853-0463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2393
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: