Healthcare Provider Details

I. General information

NPI: 1922866680
Provider Name (Legal Business Name): LIZETH CUEVAS SOTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 03/24/2024
Certification Date: 03/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2775 S 8TH AVE
YUMA AZ
85364-7110
US

IV. Provider business mailing address

6491 CLEO ST
SAN DIEGO CA
92115-1524
US

V. Phone/Fax

Practice location:
  • Phone: 928-341-0700
  • Fax:
Mailing address:
  • Phone: 619-761-9449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN213673
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number305257
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: