Healthcare Provider Details

I. General information

NPI: 1013737444
Provider Name (Legal Business Name): MS. MARISSA CUEVAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4408 9TH ST NW
ALBUQUERQUE NM
87107-3614
US

IV. Provider business mailing address

4408 9TH ST NW
ALBUQUERQUE NM
87107-3614
US

V. Phone/Fax

Practice location:
  • Phone: 505-702-7953
  • Fax:
Mailing address:
  • Phone: 505-702-7953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number90169
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number81445
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: