Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XL0004X | Low Vision | OT10075 | FL |
NPI | 1487945085 |
---|---|
Provider Name | Ms. Teresita De Jesus Cueto |
First Address | Miami, FL 33155-2335 |
Second Address | Miami, FL 33155-2751 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2011 |
Last Update Date | 23/04/2012 |