Provider Demographics
NPI:1306862743
Name:CUESTA, ANGEL L I (DPM, FACFAS, PA)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:L
Last Name:CUESTA
Suffix:I
Gender:M
Credentials:DPM, FACFAS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6831 NW 11TH PL
Mailing Address - Street 2:SUITE #3
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4259
Mailing Address - Country:US
Mailing Address - Phone:352-331-3077
Mailing Address - Fax:352-331-3265
Practice Address - Street 1:6831 NW 11TH PL STE 3
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4259
Practice Address - Country:US
Practice Address - Phone:352-331-3077
Practice Address - Fax:352-331-3265
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2016213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL054892800Medicaid
FL65174OtherBCBS
FL1074HILHOtherNEIGHBORHOOD HEALTH PARTNERSHIP
FL31257OtherCOVENTRY HEALTH
FL1074HILHOtherNEIGHBORHOOD HEALTH PARTNERSHIP
FL31257OtherCOVENTRY HEALTH