Healthcare Provider Details

I. General information

NPI: 1891519633
Provider Name (Legal Business Name): ROGELIO DAVID CUEVAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2024
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 W CRESCENT AVE STE 244
ANAHEIM CA
92801-3836
US

IV. Provider business mailing address

7142 ORANGETHORPE AVE SPC 7C
BUENA PARK CA
90621-4534
US

V. Phone/Fax

Practice location:
  • Phone: 714-829-4138
  • Fax:
Mailing address:
  • Phone: 323-599-1363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: