Provider Demographics
NPI:1154707875
Name:DISLA CUEVAS, ABIEZER NATANAEL (MD)
Entity type:Individual
Prefix:DR
First Name:ABIEZER
Middle Name:NATANAEL
Last Name:DISLA CUEVAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-8652
Mailing Address - Fax:
Practice Address - Street 1:400 E OAK AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5034
Practice Address - Country:US
Practice Address - Phone:877-960-3426
Practice Address - Fax:559-734-1247
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-04
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X
ORMD209159208000000X
CAA154728208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1154707875Medicaid