Healthcare Provider Details

I. General information

NPI: 1619477825
Provider Name (Legal Business Name): JONATHAN CUEVAS BELTRAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2018
Last Update Date: 02/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1156 CALLE 62 SE
SAN JUAN PR
00921-2724
US

IV. Provider business mailing address

URB LOS FAROLES 8 PASEO LAS GALERIAS
BAYAMON PR
00956
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: