Provider Demographics
NPI:1700844008
Name:CUETO, ROY L (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:L
Last Name:CUETO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:305-512-0484
Mailing Address - Fax:305-512-1034
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:305-512-0484
Practice Address - Fax:786-522-0234
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2816213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390491100Medicaid
FLE2767Medicare PIN
FL390491100Medicaid
FLU75901Medicare UPIN