Individual
MISS MARIELA CRISTINA CUEBAS FANTAUZZI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
950 COUNTY ROAD 17A W, AVON PARK, FL 33825-2164
(866) 234-8534
Mailing address
47 5TH ST NW, WINTER HAVEN, FL 33881-4672
(866) 234-8534
(863) 837-4441
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
23562
PR
208D00000X
General Practice Physician
Primary
ACN1643
FL
390200000X
Student in an Organized Health Care Education/Training Program
6065629
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123550500
—
FL
01
—
Z8H8N
BCBS
FL
Enumeration date
03/11/2018
Last updated
09/24/2024
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