1356192629 NPI number — FABIOLA YAREL CUEVAS ALVAREZ

Table of content: DR. AMANDA MARIE BAUM D.C. (NPI 1669773222)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356192629 NPI number — FABIOLA YAREL CUEVAS ALVAREZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FABIOLA YAREL CUEVAS ALVAREZ
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356192629
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
930 EBONY AVE APT A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IMPERIAL BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91932-2877
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARILLO PUERTO
Provider Second Line Business Practice Location Address:
1536-2023
Provider Business Practice Location Address City Name:
TIJUANA
Provider Business Practice Location Address State Name:
BAJA CALIFORNIA
Provider Business Practice Location Address Postal Code:
22000
Provider Business Practice Location Address Country Code:
MX
Provider Business Practice Location Address Telephone Number:
619-272-9021
Provider Business Practice Location Address Fax Number:
619-329-9663
Provider Enumeration Date:
03/27/2024

Additional Information

Authorized Official

Authorized Official Last Name:
CUEVAS ALVAREZ
Authorized Official First Name:
FABIOLA
Authorized Official Middle Name:
YAREL
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
619-272-9021

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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