Healthcare Provider Details

I. General information

NPI: 1598245805
Provider Name (Legal Business Name): CUEVAS DIAGNOSTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2018
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 KATY FREEWAY
HOUSTON TX
77007
US

IV. Provider business mailing address

PO BOX 130273
HOUSTON TX
77219
US

V. Phone/Fax

Practice location:
  • Phone: 713-691-9800
  • Fax: 713-695-7806
Mailing address:
  • Phone: 713-691-9800
  • Fax: 713-695-7806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: CESAR CUEVAS
Title or Position: PRESIDENT
Credential:
Phone: 713-253-3555