Roberto Edmundo Cucurullo, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9100128 Issued in FL

Practice address

7761 NW 146TH St
Miami Lakes, FL 33016-1559

Phone

(305) 822-5896

Fax

(305) 822-4260

NPI assigned

Oct 19, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1286496000000",
    "number": "1477635688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7761 NW 146TH ST",
            "city": "MIAMI LAKES",
            "state": "FL",
            "postal_code": "330161559",
            "telephone_number": "305-822-5896",
            "fax_number": "305-822-4260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7761 NW 146TH ST",
            "city": "MIAMI LAKES",
            "state": "FL",
            "postal_code": "330161559",
            "telephone_number": "305-822-5896",
            "fax_number": "305-822-4260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUCURULLO",
        "first_name": "ROBERTO",
        "middle_name": "EDMUNDO",
        "name_prefix": "Mr.",
        "credential": "P.A.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2010-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9100128",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "290459400",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AV-MED",
            "identifier": "292745",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Miami Lakes, FL
• Providers in Miami Lakes, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.