MEDICARE: JAIME CUETO OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	23809	CA

General Provider Information

NPI Number	:	1558083071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAIME CUETO OTR

Provider Business Mailing Address
First Line	:	5804 CRESCENT AVE
Second Line	:
City	:	BUENA PARK
State	:	CA
Zip	:	90620-3410
Country	:	US
Telephone Number	:	714-726-9426
Fax Number	:

Provider Business Practice Location Address
First Line	:	515 CENTINELA AVE
Second Line	:
City	:	INGLEWOOD
State	:	CA
Zip	:	90302-3215
Country	:	US
Telephone Number	:	310-674-4500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2022
Last Update Date	:	09/12/2022

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