Healthcare Provider Details

I. General information

NPI: 1396928776
Provider Name (Legal Business Name): CARY ANN CUEVAS RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2007
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14210 SE SUNNYSIDE RD
CLACKAMAS OR
97015-5240
US

IV. Provider business mailing address

7140 SE 112TH AVE
PORTLAND OR
97266-5030
US

V. Phone/Fax

Practice location:
  • Phone: 503-855-6171
  • Fax:
Mailing address:
  • Phone: 971-212-3432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD-D-10198182
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number993605
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: