Organization
MODERN MEDICAL GROUP PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IVETTE CINTRON-CUBERO FNP-C (OWNER/PRESIDENT)
(704) 497-9544
Entity
Organization
Contact information
Practice address
936 COX RD STE A, GASTONIA, NC 28054-3456
(704) 497-9544
Mailing address
10619 TROLLEY RUN DR, CORNELIUS, NC 28031-8303
(704) 497-9544
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
56545-1730570136
—
NC
Enumeration date
06/06/2019
Last updated
06/06/2019
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