Healthcare Provider Details

I. General information

NPI: 1104481183
Provider Name (Legal Business Name): LAURA ANN CUEVAS MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 LINCOLN BLVD # CA95648
LINCOLN CA
95648-1808
US

IV. Provider business mailing address

110 GATEWAY DR STE 210
LINCOLN CA
95648-3306
US

V. Phone/Fax

Practice location:
  • Phone: 916-645-3300
  • Fax:
Mailing address:
  • Phone: 916-645-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14824
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: