Provider Demographics
NPI:1932168762
Name:CUEVAS BOCANEGRA, HARRY R (MD)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:R
Last Name:CUEVAS BOCANEGRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4445 S SEMORAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-2469
Mailing Address - Country:US
Mailing Address - Phone:407-203-8957
Mailing Address - Fax:855-296-8047
Practice Address - Street 1:4445 S SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-2469
Practice Address - Country:US
Practice Address - Phone:407-203-8957
Practice Address - Fax:855-296-8047
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN530208000000X, 2080P0204X
PR9694207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010204300Medicaid