Provider Demographics
NPI:1265901029
Name:CUEVA, MERCEDES V
Entity type:Individual
Prefix:
First Name:MERCEDES
Middle Name:V
Last Name:CUEVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BEN ROLAND
Other - Middle Name:
Other - Last Name:TSHIBUABUA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PROVIDER
Mailing Address - Street 1:612 S WALTER REED DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-2206
Mailing Address - Country:US
Mailing Address - Phone:703-581-9800
Mailing Address - Fax:
Practice Address - Street 1:612 S WALTER REED DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-2206
Practice Address - Country:US
Practice Address - Phone:703-581-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WV0202XOther Service ProvidersContractorVehicle Modifications