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1962183665 NPI number — ANGEL MANUEL CUENCA GONGORA MD

NPI Number: 1962183665
Health Care Provider/Practitioner: ANGEL MANUEL CUENCA GONGORA MD

Information about “1962183665” NPI (ANGEL MANUEL CUENCA GONGORA MD) exists in 1962183665 in HTML format HTML  |  1962183665 in plain Text format TXT  |  1962183665 in PDF (Portable Document Format) PDF  |  1962183665 in an XML format XML  formats.

NPI Number : 1962183665 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1962183665",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CUENCA GONGORA",
    "FirstName": "ANGEL",
    "MiddleName": "MANUEL",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "CUENCA",
    "OtherFirstName": "ANGEL",
    "OtherMiddleName": "M",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "MD",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "6675 WESTWOOD BLVD STE 475",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ORLANDO",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32821-6027",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "407-845-0330",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "431 W OAK ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "KISSIMMEE",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "34741-6627",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "407-750-6980",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/26/2023",
    "LastUpdateDate": "02/11/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "208D00000X",
          "TaxonomyName": "General Practice Physician",
          "LicenseNumber": "24217",
          "LicenseNumberStateCode": "PR",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "208D00000X",
          "TaxonomyName": "General Practice Physician",
          "LicenseNumber": "ACN1691",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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