=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083780613
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EDNA M CUEVAS DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2006
-----------------------------------------------------
Last Update Date | 07/01/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 324 W BADILLO ST
-----------------------------------------------------
City | COVINA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91723-1827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-814-1111
-----------------------------------------------------
Fax | 626-814-0322
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1135 S SUNSET AVE STE 404
-----------------------------------------------------
City | WEST COVINA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91790
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-814-2111
-----------------------------------------------------
Fax | 626-814-0322
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 37991
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------