Provider Demographics
NPI:1679137335
Name:CUEVAS, ALLISON ANN (MPH)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:ANN
Last Name:CUEVAS
Suffix:
Gender:F
Credentials:MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3607
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-5607
Mailing Address - Country:US
Mailing Address - Phone:626-808-1114
Mailing Address - Fax:
Practice Address - Street 1:342 E ITALIA ST
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-2203
Practice Address - Country:US
Practice Address - Phone:626-720-1192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26799124Q00000X
CA712124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA833500096Medicaid
CA833500096OtherDELTA DENTAL