Healthcare Provider Details

I. General information

NPI: 1730961947
Provider Name (Legal Business Name): PABLO CUETO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 08/13/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25319 I-45 SUITE 100
SPRING TX
77380
US

IV. Provider business mailing address

25319 I-45 SUITE 100
SPRING TX
77380
US

V. Phone/Fax

Practice location:
  • Phone: 832-810-0200
  • Fax:
Mailing address:
  • Phone: 832-810-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1139834
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: