Provider Demographics
NPI:1912192113
Name:ANGEL L CUESTA DPM PA
Entity Type:Organization
Organization Name:ANGEL L CUESTA DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:LEANDRO
Authorized Official - Last Name:CUESTA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:352-331-3077
Mailing Address - Street 1:6831 NW 11TH PL
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4259
Mailing Address - Country:US
Mailing Address - Phone:352-331-3077
Mailing Address - Fax:352-331-3077
Practice Address - Street 1:6831 NW 11TH PL
Practice Address - Street 2:SUITE 3
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4259
Practice Address - Country:US
Practice Address - Phone:352-331-3077
Practice Address - Fax:352-331-3077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2016213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65174OtherBCBS
FL054892800Medicaid
FL163970470871OtherHUMANA
FL2770028OtherUNITED HEALTHCARE OF FL
FL9177366OtherCIGNA
FL31257OtherCOVENTRY HEALTH
FL816833126OtherTRICARE
FLU16884Medicare UPIN
FL816833126OtherTRICARE