Provider Demographics
NPI:1659599694
Name:CUEVA, LUPE (MD)
Entity Type:Individual
Prefix:
First Name:LUPE
Middle Name:
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 1:2209 N PEARL ST STE 100
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-2529
Mailing Address - Country:US
Mailing Address - Phone:253-792-6900
Mailing Address - Fax:
Practice Address - Street 1:2209 N PEARL ST STE 100
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-2529
Practice Address - Country:US
Practice Address - Phone:253-792-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00049122207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD00049122OtherMEDICAL LICENSE
WA8503583Medicaid
WAG8882595Medicare PIN
WAG8882607Medicare PIN