Healthcare Provider Details

I. General information

NPI: 1760444285
Provider Name (Legal Business Name): MARIA C CUENCO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4815 N ASSEMBLY ST
SPOKANE WA
99205-6185
US

IV. Provider business mailing address

4815 N ASSEMBLY ST
SPOKANE WA
99205-6185
US

V. Phone/Fax

Practice location:
  • Phone: 509-434-7000
  • Fax: 509-434-7129
Mailing address:
  • Phone: 509-434-7000
  • Fax: 509-434-7129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number233499
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: