Healthcare Provider Details

I. General information

NPI: 1053771097
Provider Name (Legal Business Name): MARISA CUEVA NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 UNIVERSITY BLVD
GALVESTON TX
77555-5302
US

IV. Provider business mailing address

5241 CUMBERLAND DR
LEAGUE CITY TX
77573-1715
US

V. Phone/Fax

Practice location:
  • Phone: 409-772-1011
  • Fax:
Mailing address:
  • Phone: 832-875-5234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP130498
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: