Healthcare Provider Details

I. General information

NPI: 1598259046
Provider Name (Legal Business Name): ALEJANDRO LUIS CUESTA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 08/03/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY CIR
OCEANSIDE CA
92055
US

IV. Provider business mailing address

USS SAN DIEGO
FPO AA
96662-1704
US

V. Phone/Fax

Practice location:
  • Phone: 760-719-3675
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0102205881
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102205881
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: