Healthcare Provider Details

I. General information

NPI: 1144952946
Provider Name (Legal Business Name): ANASTASIA CUENCO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 06/29/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20996 E CANARY WAY
QUEEN CREEK AZ
85142-3798
US

IV. Provider business mailing address

20996 E CANARY WAY
QUEEN CREEK AZ
85142-3798
US

V. Phone/Fax

Practice location:
  • Phone: 224-619-6322
  • Fax:
Mailing address:
  • Phone: 224-619-6322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: