Provider Demographics
NPI:1134452543
Name:CUEVAS, KELLEY DAWN (CPHT)
Entity type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:DAWN
Last Name:CUEVAS
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5354 NEWLAND RD
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-5330
Mailing Address - Country:US
Mailing Address - Phone:530-588-2049
Mailing Address - Fax:530-876-2528
Practice Address - Street 1:5125 SKYWAY STE F
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-5624
Practice Address - Country:US
Practice Address - Phone:530-876-2525
Practice Address - Fax:530-876-2528
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52109183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician