Provider Demographics
NPI:1427656875
Name:CUEVA VELAZQUEZ, MARIOLIS N/A (RN)
Entity type:Individual
Prefix:
First Name:MARIOLIS
Middle Name:N/A
Last Name:CUEVA VELAZQUEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:508 NIGHTINGGALE LN
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-8846
Mailing Address - Country:US
Mailing Address - Phone:305-846-6285
Mailing Address - Fax:
Practice Address - Street 1:508 NIGHTINGGALE LN
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154-8846
Practice Address - Country:US
Practice Address - Phone:305-846-6285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9519558163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse