Provider Demographics
NPI:1245041466
Name:CUETO, MARY (CHI)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:CUETO
Suffix:
Gender:F
Credentials:CHI
Other - Prefix:
Other - First Name:MARU
Other - Middle Name:
Other - Last Name:CUETO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CHI
Mailing Address - Street 1:909 N GREENSBORO ST APT B
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-1370
Mailing Address - Country:US
Mailing Address - Phone:512-789-8780
Mailing Address - Fax:
Practice Address - Street 1:909 N GREENSBORO ST APT B
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-1370
Practice Address - Country:US
Practice Address - Phone:512-789-8780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-16
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX934171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171R00000XOther Service ProvidersInterpreterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCFP272783OtherNORTH CAROLINA
NC56-1916473.OtherORANGE COUNTY HEALTH DEPARTMENT