Provider Demographics
NPI:1518008655
Name:ROBERTO J CUBEDDU MD PA
Entity Type:Organization
Organization Name:ROBERTO J CUBEDDU MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:J
Authorized Official - Last Name:CUBEDDU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-244-4355
Mailing Address - Street 1:PO BOX 403125
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-1125
Mailing Address - Country:US
Mailing Address - Phone:305-244-4355
Mailing Address - Fax:305-446-7305
Practice Address - Street 1:3625 N COUNTRY CLUB DR
Practice Address - Street 2:2408
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1729
Practice Address - Country:US
Practice Address - Phone:305-244-4355
Practice Address - Fax:305-446-7305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-10
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87165174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherEIN NUMBER
FLH95474Medicare UPIN
FLU1460Medicare PIN