Provider Demographics
NPI:1427643683
Name:CUESTA, JOSE M
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:M
Last Name:CUESTA
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 1:5791 SW 74TH TER APT 37
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5350
Mailing Address - Country:US
Mailing Address - Phone:786-536-9714
Mailing Address - Fax:786-536-9833
Practice Address - Street 1:4649 PONCE DE LEON BLVD STE 404
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2121
Practice Address - Country:US
Practice Address - Phone:104-353-7160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker