Provider Demographics
NPI:1023008083
Name:CUEVA, MARY C (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:CUEVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 S JUNIPER ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4941
Mailing Address - Country:US
Mailing Address - Phone:866-228-2236
Mailing Address - Fax:760-737-3430
Practice Address - Street 1:326 S MELROSE DR STE 200
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6618
Practice Address - Country:US
Practice Address - Phone:866-228-2236
Practice Address - Fax:760-330-9331
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG34120207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADR160ZMedicare PIN
CAA91562Medicare UPIN