Healthcare Provider Details

I. General information

NPI: 1205866779
Provider Name (Legal Business Name): JUAN E. CUEVAS ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 E CHAPMAN AVE
FULLERTON CA
92832-2011
US

IV. Provider business mailing address

21087 MAUVE
MISSION VIEJO CA
92691-6659
US

V. Phone/Fax

Practice location:
  • Phone: 714-992-7407
  • Fax:
Mailing address:
  • Phone: 714-553-3364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: