Healthcare Provider Details

I. General information

NPI: 1659742369
Provider Name (Legal Business Name): DR. MARKEE CUEVAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PROF. LACEY PEDERSEN

II. Dates (important events)

Enumeration Date: 10/08/2015
Last Update Date: 10/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19951 EAST HIGHWAY 120
ESCALON CA
95320
US

IV. Provider business mailing address

601 W GRANGER AVE APT 105
MODESTO CA
95350-4134
US

V. Phone/Fax

Practice location:
  • Phone: 209-838-9940
  • Fax:
Mailing address:
  • Phone: 209-838-9940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: