Healthcare Provider Details

I. General information

NPI: 1992976930
Provider Name (Legal Business Name): YOBANI CUEVAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 09/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6355 S RILEY ST UNIT 108
LAS VEGAS NV
89148-1332
US

IV. Provider business mailing address

6355 S RILEY ST UNIT 108
LAS VEGAS NV
89148-1332
US

V. Phone/Fax

Practice location:
  • Phone: 619-569-3305
  • Fax:
Mailing address:
  • Phone: 619-569-3305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: