Healthcare Provider Details

I. General information

NPI: 1023766110
Provider Name (Legal Business Name): JESSICA CUESTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2022
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 W OLIVE AVE
BURBANK CA
91502-1825
US

IV. Provider business mailing address

241 W OLIVE AVE
BURBANK CA
91502-1825
US

V. Phone/Fax

Practice location:
  • Phone: 818-848-5561
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95023738
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: