Provider Demographics
NPI:1407171986
Name:CUMENTO, SALVACION BAUTISTA
Entity Type:Individual
Prefix:
First Name:SALVACION
Middle Name:BAUTISTA
Last Name:CUMENTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8925 182ND PL
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-1741
Mailing Address - Country:US
Mailing Address - Phone:718-657-0038
Mailing Address - Fax:
Practice Address - Street 1:8925 182ND PL
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-1741
Practice Address - Country:US
Practice Address - Phone:718-657-0038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037670183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist