Provider Demographics
NPI:1699280859
Name:CUCOS, RAISA I (RNA)
Entity type:Individual
Prefix:
First Name:RAISA
Middle Name:
Last Name:CUCOS
Suffix:I
Gender:F
Credentials:RNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19037 104TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-2924
Mailing Address - Country:US
Mailing Address - Phone:425-483-6805
Mailing Address - Fax:425-892-8607
Practice Address - Street 1:19037 104TH AVE NE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-2924
Practice Address - Country:US
Practice Address - Phone:425-483-6805
Practice Address - Fax:425-892-8607
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-11
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging