Provider Demographics
NPI:1740496827
Name:CUESTA, IRENE MARIA (PA-C)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:MARIA
Last Name:CUESTA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13874 SW 75TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-3010
Mailing Address - Country:US
Mailing Address - Phone:305-573-7200
Mailing Address - Fax:
Practice Address - Street 1:4770 BISCAYNE BLVD STE 1140
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-3247
Practice Address - Country:US
Practice Address - Phone:305-573-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0003643363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant