Healthcare Provider Details

I. General information

NPI: 1174992226
Provider Name (Legal Business Name): MARGARITO CUEN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2015
Last Update Date: 09/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 N GAREY AVE
POMONA CA
91767-2722
US

IV. Provider business mailing address

2008 N GAREY AVE
POMONA CA
91767-2722
US

V. Phone/Fax

Practice location:
  • Phone: 909-623-6131
  • Fax: 909-865-9281
Mailing address:
  • Phone: 909-623-6131
  • Fax: 909-865-9281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: