Healthcare Provider Details

I. General information

NPI: 1154707875
Provider Name (Legal Business Name): ABIEZER NATANAEL DISLA CUEVAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E OAK AVE
VISALIA CA
93291-5034
US

IV. Provider business mailing address

3181 SW SAM JACKSON PARK RD
PORTLAND OR
97239-3011
US

V. Phone/Fax

Practice location:
  • Phone: 877-960-3426
  • Fax: 559-734-1247
Mailing address:
  • Phone: 503-494-8652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD209159
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA154728
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: