Healthcare Provider Details

I. General information

NPI: 1104484013
Provider Name (Legal Business Name): LENA AGUILAR CUEVAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5325 N. FRESNO ST. SUITE 106
FRESNO CA
93710
US

IV. Provider business mailing address

500 FAIRWAY DRIVE, SUITE 102 DEERFIELD BEACH, FL 33441
DEERFIELD BEACH FL
33441
US

V. Phone/Fax

Practice location:
  • Phone: 877-418-2978
  • Fax: 866-500-2186
Mailing address:
  • Phone: 877-418-2978
  • Fax: 866-500-2186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: