Provider Demographics
NPI:1184665481
Name:DE LA CUESTA, DOLORES CRISTINA (MS)
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:CRISTINA
Last Name:DE LA CUESTA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17658 SW 135TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-7158
Mailing Address - Country:US
Mailing Address - Phone:786-306-7866
Mailing Address - Fax:
Practice Address - Street 1:9900 STIRLING RD STE 103
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-8073
Practice Address - Country:US
Practice Address - Phone:954-300-2921
Practice Address - Fax:954-529-2001
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL765647500Medicaid