Provider Demographics
NPI:1821383969
Name:CUEVAS, LISETTE (LMP)
Entity Type:Individual
Prefix:
First Name:LISETTE
Middle Name:
Last Name:CUEVAS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11300 3RD AVE NE APT 110
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-6037
Mailing Address - Country:US
Mailing Address - Phone:206-240-5138
Mailing Address - Fax:
Practice Address - Street 1:3002 NE 127TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-4415
Practice Address - Country:US
Practice Address - Phone:206-306-2494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60168964174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist