Healthcare Provider Details

I. General information

NPI: 1356192629
Provider Name (Legal Business Name): FABIOLA YAREL CUEVAS ALVAREZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2024
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARILLO PUERTO 1536-2023
TIJUANA BAJA CALIFORNIA
22000
MX

IV. Provider business mailing address

930 EBONY AVE APT A
IMPERIAL BEACH CA
91932-2877
US

V. Phone/Fax

Practice location:
  • Phone: 619-272-9021
  • Fax: 619-329-9663
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. FABIOLA YAREL CUEVAS ALVAREZ
Title or Position: DENTIST
Credential: DDS
Phone: 619-272-9021