Healthcare Provider Details

I. General information

NPI: 1144932336
Provider Name (Legal Business Name): BETHSAIDA CUEVAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 07/03/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 MYERS ST
RIVERSIDE CA
92503-5527
US

IV. Provider business mailing address

3125 MYERS ST
RIVERSIDE CA
92503-5527
US

V. Phone/Fax

Practice location:
  • Phone: 951-358-3415
  • Fax:
Mailing address:
  • Phone: 951-358-3415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number153983
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: