Healthcare Provider Details

I. General information

NPI: 1942759154
Provider Name (Legal Business Name): VANESSA GABROVSKY CUELLAR MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2016
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N ROXBURY DR 3RD FLOOR
BEVERLY HILLS CA
90210-4231
US

IV. Provider business mailing address

450 N ROXBURY DR 3RD FLOOR
BEVERLY HILLS CA
90210-4231
US

V. Phone/Fax

Practice location:
  • Phone: 310-385-7766
  • Fax:
Mailing address:
  • Phone: 310-385-7766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA134536
License Number StateCA

VIII. Authorized Official

Name: DR. VANESSA GABROVSKY CUELLAR
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MD
Phone: 917-744-7591