Healthcare Provider Details

I. General information

NPI: 1235161274
Provider Name (Legal Business Name): EDUARDO CIFUENTES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 11/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2777 SPEISSEGGER DR
CHARLESTON SC
29405-8229
US

IV. Provider business mailing address

2777 SPEISSEGGER DRIVE
CHARLESTON SC
29405-8299
US

V. Phone/Fax

Practice location:
  • Phone: 843-745-5153
  • Fax: 843-766-8606
Mailing address:
  • Phone: 843-745-5153
  • Fax: 843-766-8606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number26779
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: