Provider Demographics
NPI:1508168881
Name:CUEVA, WALTER FRANCISCO (CNA00513523)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:FRANCISCO
Last Name:CUEVA
Suffix:
Gender:M
Credentials:CNA00513523
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:778 ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-3114
Mailing Address - Country:US
Mailing Address - Phone:805-404-4477
Mailing Address - Fax:805-285-0644
Practice Address - Street 1:778 ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-3114
Practice Address - Country:US
Practice Address - Phone:805-404-4477
Practice Address - Fax:805-285-0644
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00157264374U00000X
CA00513523376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00157264OtherHOME HEALTH AIDE (HHA)