1619543618 NPI number — CUALS MD, LLC

Table of content: (NPI 1619543618)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619543618 NPI number — CUALS MD, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CUALS MD, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619543618
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELFAST
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04915-9100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-300-2410
Provider Business Mailing Address Fax Number:
561-235-7292

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7000 SW 62ND AVE STE 545
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33143-4724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-665-2060
Provider Business Practice Location Address Fax Number:
305-665-3600
Provider Enumeration Date:
06/01/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HERNANDEZ
Authorized Official First Name:
ERICA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
561-300-2410

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VF0040X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)