MEDICARE: IRENE MARIA CUESTA PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	0003643	FL

General Provider Information

NPI Number	:	1740496827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRENE MARIA CUESTA PA-C

Provider Business Mailing Address
First Line	:	13874 SW 75TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-3010
Country	:	US
Telephone Number	:	305-573-7200
Fax Number	:

Provider Business Practice Location Address
First Line	:	4770 BISCAYNE BLVD STE 1140
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33137-3247
Country	:	US
Telephone Number	:	305-573-7200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	07/08/2007

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Directions to “ IRENE MARIA CUESTA PA-C” Practice Location

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