Healthcare Provider Details

I. General information

NPI: 1154083236
Provider Name (Legal Business Name): GUILLERMO CUEVAS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 MONROE CT UNIT 100
HOLLISTER CA
95023-6964
US

IV. Provider business mailing address

9460 N NAME UNO STE 140
GILROY CA
95020-3532
US

V. Phone/Fax

Practice location:
  • Phone: 831-676-1623
  • Fax:
Mailing address:
  • Phone: 408-847-0107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT301027
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: