Healthcare Provider Details

I. General information

NPI: 1588287742
Provider Name (Legal Business Name): VICTORIA CUEBAS HINER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VICTORIA CUEBAS DO

II. Dates (important events)

Enumeration Date: 05/22/2020
Last Update Date: 01/23/2021
Certification Date: 01/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HARRINGTON ST
MOUNT CLEMENS MI
48043-2920
US

IV. Provider business mailing address

1000 HARRINGTON ST
MOUNT CLEMENS MI
48043-2920
US

V. Phone/Fax

Practice location:
  • Phone: 586-790-9003
  • Fax:
Mailing address:
  • Phone: 586-790-9003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5151014607
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: