Provider Demographics
NPI:1134254691
Name:OSORIO CUEVA, EDISSON H (MD)
Entity type:Individual
Prefix:DR
First Name:EDISSON
Middle Name:H
Last Name:OSORIO CUEVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:PR
Mailing Address - Zip Code:00677-0159
Mailing Address - Country:US
Mailing Address - Phone:787-826-2858
Mailing Address - Fax:787-826-6428
Practice Address - Street 1:CLL MANUEL B MALAVE #15
Practice Address - Street 2:
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610-9998
Practice Address - Country:US
Practice Address - Phone:787-826-2858
Practice Address - Fax:787-826-6428
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6306208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE-08250Medicare UPIN