Provider Demographics
NPI:1508900572
Name:CUBELA, EUDELISA
Entity Type:Individual
Prefix:MRS
First Name:EUDELISA
Middle Name:
Last Name:CUBELA
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 1:3335 HYDER AVE
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738
Mailing Address - Country:US
Mailing Address - Phone:386-532-0624
Mailing Address - Fax:386-532-0624
Practice Address - Street 1:3335 HYDER AVE
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32738
Practice Address - Country:US
Practice Address - Phone:386-532-0624
Practice Address - Fax:386-532-0624
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
385H00000X, 3747P1801X
FL376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered385H00000XRespite Care FacilityRespite Care
Not Answered3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Not Answered376J00000XNursing Service Related ProvidersHomemaker