Healthcare Provider Details

I. General information

NPI: 1881275121
Provider Name (Legal Business Name): ROBERTO DANIEL CUEVAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 NE 10TH ST STE 3029
OKLAHOMA CITY OK
73104-5418
US

IV. Provider business mailing address

800 NE 10TH ST STE 3029
OKLAHOMA CITY OK
73104-5418
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-8778
  • Fax: 405-271-3468
Mailing address:
  • Phone: 405-271-8778
  • Fax: 405-271-3468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberT-26673
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: