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General NPI Number Information
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NPI Number | 1962183665
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Entity Type | Individual
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Provider Name | ANGEL MANUEL CUENCA GONGORA MD
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Gender | Male
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Dates
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Enumeration Date | 07/26/2023
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 431 W OAK ST
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City | KISSIMMEE
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State | FL
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Zip | 34741-6627
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Country | US
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Telephone | 407-750-6980
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Fax |
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Provider Business Mailing Address
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Address Line | 6675 WESTWOOD BLVD STE 475
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City | ORLANDO
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State | FL
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Zip | 32821-6027
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Country | US
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Telephone | 407-845-0330
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 24217
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ACN1691
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License Number State | FL
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