Provider Demographics
NPI:1407433212
Name:CUETO, EDA CHRISTIE PALANCA
Entity Type:Individual
Prefix:
First Name:EDA CHRISTIE
Middle Name:PALANCA
Last Name:CUETO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 N CENTRAL AVENUE
Mailing Address - Street 2:APT 76
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-1353
Mailing Address - Country:US
Mailing Address - Phone:602-883-5500
Mailing Address - Fax:
Practice Address - Street 1:1408 N CENTRAL AVENUE
Practice Address - Street 2:APT 76
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-1353
Practice Address - Country:US
Practice Address - Phone:602-883-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ264455374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide