Healthcare Provider Details

I. General information

NPI: 1700456738
Provider Name (Legal Business Name): MARIA CUEVAS-ALTAMIRANO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 03/25/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17203 JASMINE ST
VICTORVILLE CA
92395
US

IV. Provider business mailing address

17203 JASMINE ST
VICTORVILLE CA
92395
US

V. Phone/Fax

Practice location:
  • Phone: 760-881-3377
  • Fax: 760-881-3379
Mailing address:
  • Phone: 760-881-3377
  • Fax: 760-881-3379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95026305
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95020314
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: