Basic Information
| Provider Information | |||||||||
| NPI: | 1114226941 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARIA LUISA S CUEVAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1050 ISSAC STS | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | OREGON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436163291 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196984642 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7550 LUCERNE DR | ||||||||
| Address2: | SUITE 405 | ||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441306588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005566236 | ||||||||
| FaxNumber: | 4402343313 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2011 | ||||||||
| LastUpdateDate: | 03/18/2011 | ||||||||
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| AuthorizedOfficialLastName: | CUEVAS | ||||||||
| AuthorizedOfficialFirstName: | MARIA LUISA | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 4196984642 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4029101 | OH | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0323171 | 05 | OH | MEDICAID |