Healthcare Provider Details

I. General information

NPI: 1710456892
Provider Name (Legal Business Name): BLANCA CUEVAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2018
Last Update Date: 11/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 N 37TH ST
KANSAS CITY KS
66104-3634
US

IV. Provider business mailing address

2320 N 37TH ST
KANSAS CITY KS
66104-3634
US

V. Phone/Fax

Practice location:
  • Phone: 913-375-7991
  • Fax: 913-904-3413
Mailing address:
  • Phone: 913-375-7991
  • Fax: 913-904-3413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: