Healthcare Provider Details

I. General information

NPI: 1548082878
Provider Name (Legal Business Name): RICARDO CUEVAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 RUGBY AVE
HUNTINGTON PARK CA
90255-4066
US

IV. Provider business mailing address

1400 S GRAND AVE STE 600
LOS ANGELES CA
90015-3068
US

V. Phone/Fax

Practice location:
  • Phone: 213-742-6250
  • Fax:
Mailing address:
  • Phone: 213-742-6250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: