Healthcare Provider Details

I. General information

NPI: 1417133174
Provider Name (Legal Business Name): LUIS R. CUEVA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2008
Last Update Date: 12/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 N BROADWAY SUITE 120
SANTA ANA CA
92701-3440
US

IV. Provider business mailing address

1212 N BROADWAY SUITE 120
SANTA ANA CA
92701-3440
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-7784
  • Fax: 714-835-7726
Mailing address:
  • Phone: 714-834-7784
  • Fax: 714-835-7726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC25131
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: