1679578256 NPI number — DR. JUAN E CUEBAS MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679578256 NPI number — DR. JUAN E CUEBAS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUEBAS
Provider First Name:
JUAN
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1679578256
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
860 OMNI BLVD
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
NEWPORT NEWS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23606-4430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-232-8769
Provider Business Mailing Address Fax Number:
757-232-8875

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
535 FAUNCE CORNER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DARTMOUTH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02747-1242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-996-3991
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/20/2005

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: 2084N0400X , with the licence number:  0101230740 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084N0400X , with the licence number: 246145 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RS0012X , with the licence number: 246145 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 182725001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1679578256 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00828641 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 431560263 . This is a "TRICARE WEST" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 007115954 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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