Provider Demographics
NPI:1831524958
Name:CUELLAR DUQUE, YOSMANY (MT)
Entity type:Individual
Prefix:
First Name:YOSMANY
Middle Name:
Last Name:CUELLAR DUQUE
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3430 W LAMBRIGHT ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-4750
Mailing Address - Country:US
Mailing Address - Phone:813-872-7209
Mailing Address - Fax:813-872-7207
Practice Address - Street 1:3430 W LAMBRIGHT ST
Practice Address - Street 2:SUITE 104
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-4750
Practice Address - Country:US
Practice Address - Phone:813-872-7209
Practice Address - Fax:813-872-7207
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA73489225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist