Provider Demographics
NPI:1043314107
Name:GONZALEZ-CUETO, ROBERTO (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:
Last Name:GONZALEZ-CUETO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 NW 72 AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126
Mailing Address - Country:US
Mailing Address - Phone:305-597-0869
Mailing Address - Fax:305-597-0873
Practice Address - Street 1:1150 NW 72 AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126
Practice Address - Country:US
Practice Address - Phone:305-597-0869
Practice Address - Fax:305-597-0873
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100804363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9100804OtherP.A. LICENSE