Individual
MISS MARIELA CRISTINA CUEBAS FANTAUZZI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
13995 W STATLER BLVD STE 200, SURPRISE, AZ 85374-5503
(602) 478-3100
Mailing address
13995 W STATLER BLVD STE 200, SURPRISE, AZ 85374-5503
(602) 478-3100
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
23562
PR
208D00000X
General Practice Physician
ACN1643
FL
390200000X
Student in an Organized Health Care Education/Training Program
6065629
PR
390200000X
Student in an Organized Health Care Education/Training Program
Primary
R82401
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123550500
—
FL
01
—
Z8H8N
BCBS
FL
Enumeration date
03/11/2018
Last updated
06/03/2026
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