Healthcare Provider Details

I. General information

NPI: 1184108938
Provider Name (Legal Business Name): ERIKA CUEVAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 S RAYMOND AVE STE 4B
FULLERTON CA
92831-5201
US

IV. Provider business mailing address

701 S RAYMOND AVE STE 4B
FULLERTON CA
92831-5201
US

V. Phone/Fax

Practice location:
  • Phone: 714-992-2999
  • Fax: 714-992-0759
Mailing address:
  • Phone: 714-992-2999
  • Fax: 714-992-0759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019031891
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: