Healthcare Provider Details

I. General information

NPI: 1134452543
Provider Name (Legal Business Name): KELLEY DAWN CUEVAS CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 09/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5125 SKYWAY STE F
PARADISE CA
95969-5624
US

IV. Provider business mailing address

5354 NEWLAND RD
PARADISE CA
95969-5330
US

V. Phone/Fax

Practice location:
  • Phone: 530-876-2525
  • Fax: 530-876-2528
Mailing address:
  • Phone: 530-588-2049
  • Fax: 530-876-2528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number52109
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: