Healthcare Provider Details

I. General information

NPI: 1447055157
Provider Name (Legal Business Name): JAVIER CUEVAS SANTOS MOLNAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E WOOD ST
SPARTANBURG SC
29303-3040
US

IV. Provider business mailing address

PO BOX 746639
ATLANTA GA
30374-6639
US

V. Phone/Fax

Practice location:
  • Phone: 864-560-4304
  • Fax: 864-560-4023
Mailing address:
  • Phone: 864-560-4304
  • Fax: 864-560-4023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number156422
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number30929
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR0121343
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: