=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558439323
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VICTOR CUEVAS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | HCO1 BUZON 2444
-----------------------------------------------------
City | LAS MARIAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00670
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-827-4846
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | HCO1 BUZON 2444
-----------------------------------------------------
City | LAS MARIAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00670
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-827-4846
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 10622
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------