Healthcare Provider Details

I. General information

NPI: 1225744626
Provider Name (Legal Business Name): LISA CUEVAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2023
Last Update Date: 01/30/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3512 224TH ST E
SPANAWAY WA
98387-7407
US

IV. Provider business mailing address

3512 224TH ST E
SPANAWAY WA
98387-7407
US

V. Phone/Fax

Practice location:
  • Phone: 206-291-4405
  • Fax:
Mailing address:
  • Phone: 206-291-4405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License NumberMC55611
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: