Healthcare Provider Details

I. General information

NPI: 1679137335
Provider Name (Legal Business Name): ALLISON ANN CUEVAS MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2019
Last Update Date: 04/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 E ITALIA ST
COVINA CA
91723-2203
US

IV. Provider business mailing address

PO BOX 3607
COVINA CA
91722-5607
US

V. Phone/Fax

Practice location:
  • Phone: 626-720-1192
  • Fax:
Mailing address:
  • Phone: 626-808-1114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number26799
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number712
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: