Provider Demographics
NPI:1356667638
Name:CARLOS IVAN CUEVAS SERRANO
Entity Type:Organization
Organization Name:CARLOS IVAN CUEVAS SERRANO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:I
Authorized Official - Last Name:CUEVAS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:939-344-0540
Mailing Address - Street 1:PO BOX 2375
Mailing Address - Street 2:
Mailing Address - City:UTUADO
Mailing Address - State:PR
Mailing Address - Zip Code:00641
Mailing Address - Country:US
Mailing Address - Phone:939-334-0540
Mailing Address - Fax:787-369-7990
Practice Address - Street 1:CARR 111 R603 K1 H9
Practice Address - Street 2:BO. RONCADOR
Practice Address - City:UTUADO
Practice Address - State:PR
Practice Address - Zip Code:00641-2375
Practice Address - Country:US
Practice Address - Phone:939-334-0540
Practice Address - Fax:787-369-7990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-12
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR43961223416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport