Healthcare Provider Details

I. General information

NPI: 1629652516
Provider Name (Legal Business Name): CARLOS RODRIGO CUENCA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 10/12/2024
Certification Date: 10/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2335 STOCKTON BOULEVARD
SACRAMENTO CA
95817
US

IV. Provider business mailing address

2335 STOCKTON BOULEVARD
SACRAMENTO CA
95817
US

V. Phone/Fax

Practice location:
  • Phone: 917-734-2724
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA198808
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: