Healthcare Provider Details

I. General information

NPI: 1669867537
Provider Name (Legal Business Name): MARCO CUEVAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 INDUSTRIAL RD STE 100
LAS VEGAS NV
89102
US

IV. Provider business mailing address

1800 INDUSTRIAL RD STE 100
LAS VEGAS NV
89102-2685
US

V. Phone/Fax

Practice location:
  • Phone: 702-474-4104
  • Fax: 702-474-4108
Mailing address:
  • Phone: 702-474-4104
  • Fax: 702-474-4108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number01124-INTERN
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: