Healthcare Provider Details

I. General information

NPI: 1043567852
Provider Name (Legal Business Name): CARLA SUAREZ REYES-CUERVA OT,CHT.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2012
Last Update Date: 08/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7005 N MAPLE AVE SUITE 104
FRESNO CA
93720-8009
US

IV. Provider business mailing address

5455 N MARTY AVE APT. #113
FRESNO CA
93711-6551
US

V. Phone/Fax

Practice location:
  • Phone: 559-325-3503
  • Fax: 559-325-3504
Mailing address:
  • Phone: 559-960-6340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT2716
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: