Healthcare Provider Details

I. General information

NPI: 1912253410
Provider Name (Legal Business Name): LILIA A. CUENCA RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2012
Last Update Date: 08/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 COLES AVE
CHERRY HILL NJ
08002-1221
US

IV. Provider business mailing address

6 COLES AVE
CHERRY HILL NJ
08002-1221
US

V. Phone/Fax

Practice location:
  • Phone: 856-383-7149
  • Fax:
Mailing address:
  • Phone: 856-383-7149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number847501
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: