Healthcare Provider Details

I. General information

NPI: 1083903827
Provider Name (Legal Business Name): MIGUEL ANGEL CUEVAS FIGUEROA M.PSY.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. SANTA CLARA C/5 #146
SAN LORENZO PR
00754
US

IV. Provider business mailing address

C/5 SANTA CLARA #146
SAN LORENZO PR
00754
US

V. Phone/Fax

Practice location:
  • Phone: 787-459-6088
  • Fax:
Mailing address:
  • Phone: 787-459-6088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number3973
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: