Healthcare Provider Details

I. General information

NPI: 1861102311
Provider Name (Legal Business Name): MARIEL CUENTO NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2022
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2795 W LINCOLN AVE STE C
ANAHEIM CA
92801-6334
US

IV. Provider business mailing address

2795 W LINCOLN AVE STE C
ANAHEIM CA
92801-6334
US

V. Phone/Fax

Practice location:
  • Phone: 714-886-2959
  • Fax:
Mailing address:
  • Phone: 714-886-2959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95023086
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: