Healthcare Provider Details

I. General information

NPI: 1043714835
Provider Name (Legal Business Name): MS. CORAZON D CUEVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 03/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 FULTON AVE
SACRAMENTO CA
95825-4272
US

IV. Provider business mailing address

3706 KINGS WAY APT 1
SACRAMENTO CA
95821-6461
US

V. Phone/Fax

Practice location:
  • Phone: 916-974-2599
  • Fax:
Mailing address:
  • Phone: 916-207-9219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: