Healthcare Provider Details

I. General information

NPI: 1508168881
Provider Name (Legal Business Name): WALTER FRANCISCO CUEVA C.N.A.00513523
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2010
Last Update Date: 11/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

778 ASHLAND AVE
SIMI VALLEY CA
93065-3114
US

IV. Provider business mailing address

778 ASHLAND AVE
SIMI VALLEY CA
93065-3114
US

V. Phone/Fax

Practice location:
  • Phone: 805-404-4477
  • Fax: 805-285-0644
Mailing address:
  • Phone: 805-404-4477
  • Fax: 805-285-0644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number00157264
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number00513523
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: