Provider Demographics
NPI:1578311924
Name:OGAZA CUETO, RAISA
Entity type:Individual
Prefix:
First Name:RAISA
Middle Name:
Last Name:OGAZA CUETO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 CALLE DE DIEGO APT 5
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00923-3134
Mailing Address - Country:US
Mailing Address - Phone:787-218-2650
Mailing Address - Fax:
Practice Address - Street 1:474 CALLE DE DIEGO APT 5
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-3134
Practice Address - Country:US
Practice Address - Phone:787-218-2650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7836103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical