Healthcare Provider Details

I. General information

NPI: 1942972567
Provider Name (Legal Business Name): JENNY CUEVAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNY CUEVAS JENNY CUEVAS

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 10/01/2021
Certification Date: 10/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1085 W BADILLO ST
COVINA CA
91722-4112
US

IV. Provider business mailing address

4895 PASTEL LN
ONTARIO CA
91762-7581
US

V. Phone/Fax

Practice location:
  • Phone: 332-626-8138
  • Fax:
Mailing address:
  • Phone: 323-245-4300
  • 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: