Healthcare Provider Details

I. General information

NPI: 1467289728
Provider Name (Legal Business Name): ANDREA CORINA CUCE SUDCC 19084
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W MORRISON AVE STE B
SANTA MARIA CA
93458-6124
US

IV. Provider business mailing address

401 W MORRISON AVE STE B
SANTA MARIA CA
93458-6124
US

V. Phone/Fax

Practice location:
  • Phone: 805-347-3338
  • Fax: 866-729-9741
Mailing address:
  • Phone: 805-347-3338
  • Fax: 866-404-4007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberSUDCC19084
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: