Provider Demographics
NPI:1780205799
Name:RUIZ CUETO, ELIO JAVIER
Entity type:Individual
Prefix:
First Name:ELIO
Middle Name:JAVIER
Last Name:RUIZ CUETO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19630 W LAKE DR
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-2249
Mailing Address - Country:US
Mailing Address - Phone:786-856-2518
Mailing Address - Fax:
Practice Address - Street 1:19630 W LAKE DR
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-2249
Practice Address - Country:US
Practice Address - Phone:786-856-2518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-30
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20-116683106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty