Healthcare Provider Details

I. General information

NPI: 1902525132
Provider Name (Legal Business Name): MS. JASMINE ROSE CUENCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 W 6TH ST
CLEVELAND OH
44113-1354
US

IV. Provider business mailing address

15 PHILLIP RD
DERRY NH
03038-4324
US

V. Phone/Fax

Practice location:
  • Phone: 216-687-1900
  • Fax:
Mailing address:
  • Phone: 603-548-8143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: