Healthcare Provider Details

I. General information

NPI: 1932947397
Provider Name (Legal Business Name): MARIO ROBERTO CUEVAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2024
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N LANTANA ST STE 259
CAMARILLO CA
93010-9008
US

IV. Provider business mailing address

3587 SWEETWOOD ST
SIMI VALLEY CA
93063-2535
US

V. Phone/Fax

Practice location:
  • Phone: 820-426-1545
  • Fax:
Mailing address:
  • Phone: 661-388-7020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: