Basic Information
| Provider Information | |||||||||
| NPI: | 1558083071 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | CUETO | ||||||||
| FirstName: | JAIME | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5804 CRESCENT AVE | ||||||||
| Address2: | |||||||||
| City: | BUENA PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906203410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147269426 | ||||||||
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| Practice Location | |||||||||
| Address1: | 515 CENTINELA AVE | ||||||||
| Address2: | |||||||||
| City: | INGLEWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 903023215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106744500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2022 | ||||||||
| LastUpdateDate: | 09/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 23809 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.