Healthcare Provider Details

I. General information

NPI: 1205910056
Provider Name (Legal Business Name): DR. ANDRES CUEVAS LARA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9326 LANHAM-SEVERN RD
LANHAM MD
20706
US

IV. Provider business mailing address

9326 LANHAM-SEVERN RD
LANHAM MD
20706
US

V. Phone/Fax

Practice location:
  • Phone: 301-459-7220
  • Fax: 301-459-8229
Mailing address:
  • Phone: 301-459-7220
  • Fax: 301-459-8229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberD0016197
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: