1518036805 NPI number — MRS. ANGELA MARIA CUEVAS RD, LD

Table of content: MRS. ANGELA MARIA CUEVAS RD, LD (NPI 1518036805)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518036805 NPI number — MRS. ANGELA MARIA CUEVAS RD, LD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUEVAS
Provider First Name:
ANGELA
Provider Middle Name:
MARIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD, LD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BLACKWELL
Provider Other First Name:
ANGELA
Provider Other Middle Name:
MARIA
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RD, LD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1518036805
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
526 MOCKINGBIRD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONG BEACH
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39560-3100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
228-865-3653
Provider Business Mailing Address Fax Number:
228-867-4139

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4500 13TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GULFPORT
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39501-2515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-865-3653
Provider Business Practice Location Address Fax Number:
228-867-4139
Provider Enumeration Date:
11/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  D1010 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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