Healthcare Provider Details

I. General information

NPI: 1396290631
Provider Name (Legal Business Name): ROXANNE CUEVA M.S., MFTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2016
Last Update Date: 08/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 VIEWRIDGE AVE
SAN DIEGO CA
92123-1638
US

IV. Provider business mailing address

4660 VIEWRIDGE AVE
SAN DIEGO CA
92123-1638
US

V. Phone/Fax

Practice location:
  • Phone: 858-656-2510
  • Fax: 858-565-0827
Mailing address:
  • Phone: 858-656-2510
  • Fax: 858-565-0827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF94366
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: