Healthcare Provider Details

I. General information

NPI: 1336377522
Provider Name (Legal Business Name): ELOINA CUEVAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18623 E. GALE
CITY OF INDUSTRY CA
91748
US

IV. Provider business mailing address

502 E ADA AVE
GLENDORA CA
91741-3515
US

V. Phone/Fax

Practice location:
  • Phone: 626-839-0300
  • Fax:
Mailing address:
  • Phone: 323-313-3166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: