Healthcare Provider Details

I. General information

NPI: 1336052588
Provider Name (Legal Business Name): THERESE-MAE CUEVAS LIM
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 SW SALMON ST FL 11
PORTLAND OR
97204-2908
US

IV. Provider business mailing address

3270 N VANCOUVER AVE APT 502
PORTLAND OR
97227-2042
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone: 702-937-3028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: