Provider Demographics
NPI:1326064080
Name:ROY L CUETO DPM PA
Entity Type:Organization
Organization Name:ROY L CUETO DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CUETO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:305-512-1033
Mailing Address - Street 1:115 NW 132ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182-1110
Mailing Address - Country:US
Mailing Address - Phone:305-512-1033
Mailing Address - Fax:305-512-1033
Practice Address - Street 1:4389 W 16TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7628
Practice Address - Country:US
Practice Address - Phone:305-512-1033
Practice Address - Fax:786-522-0234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2816213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65730OtherBCBS
FL390491100Medicaid
FL65730OtherBCBS
K5891Medicare PIN