Provider Demographics
NPI:1902045701
Name:CUEVAS, MIRTA M (RN, PHN)
Entity Type:Individual
Prefix:
First Name:MIRTA
Middle Name:M
Last Name:CUEVAS
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 NORTHGATE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-3664
Mailing Address - Country:US
Mailing Address - Phone:415-473-2623
Mailing Address - Fax:
Practice Address - Street 1:899 NORTHGATE DR STE 100
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-3664
Practice Address - Country:US
Practice Address - Phone:415-473-2623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA467948163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health