Provider Demographics
NPI:1851664130
Name:CUEVA VERTIZ, CARLOS EDUARDO (CDOE)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:EDUARDO
Last Name:CUEVA VERTIZ
Suffix:
Gender:M
Credentials:CDOE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 JASPER ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-1330
Mailing Address - Country:US
Mailing Address - Phone:401-453-6689
Mailing Address - Fax:
Practice Address - Street 1:44 JASPER ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-1330
Practice Address - Country:US
Practice Address - Phone:401-453-6689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN45832163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator