Healthcare Provider Details

I. General information

NPI: 1487885992
Provider Name (Legal Business Name): MARISSA G CUEVAS RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2009
Last Update Date: 07/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 MEDICAL CENTER PT SUITE 210
COLORADO SPRINGS CO
80907-8731
US

IV. Provider business mailing address

2 S CASCADE AVE SUITE 140
COLORADO SPRINGS CO
80903-1624
US

V. Phone/Fax

Practice location:
  • Phone: 719-635-5803
  • Fax:
Mailing address:
  • Phone: 719-538-2936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: