Provider Demographics
NPI:1902028525
Name:CUEVAS, ESTELLA (COTA)
Entity Type:Individual
Prefix:MISS
First Name:ESTELLA
Middle Name:
Last Name:CUEVAS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:482W SAN YSIDRO BLVD #1487
Mailing Address - Street 2:
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92173
Mailing Address - Country:US
Mailing Address - Phone:858-514-0375
Mailing Address - Fax:
Practice Address - Street 1:251 LANDIS AVE.
Practice Address - Street 2:SUITE 201
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910
Practice Address - Country:US
Practice Address - Phone:619-498-8450
Practice Address - Fax:619-498-8453
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA 451224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant