Healthcare Provider Details

I. General information

NPI: 1083750954
Provider Name (Legal Business Name): JUDITH CUENCA OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 YAHOME ST.
NAPA CA
94558
US

IV. Provider business mailing address

2558 HARVEST LN
NAPA CA
94558-2567
US

V. Phone/Fax

Practice location:
  • Phone: 707-259-8711
  • Fax: 707-253-6216
Mailing address:
  • Phone: 707-254-0620
  • Fax: 707-254-0620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number4672
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: