Healthcare Provider Details

I. General information

NPI: 1477819829
Provider Name (Legal Business Name): SALVADOR CUELLAR HERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 11/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82900 AVENUE 42ND SUITE G-101
INDIO CA
92203
US

IV. Provider business mailing address

72780 COUNTRY CLUB DR STE 100
RANCHO MIRAGE CA
92270-4150
US

V. Phone/Fax

Practice location:
  • Phone: 760-773-9750
  • Fax: 760-773-9294
Mailing address:
  • Phone: 760-773-9750
  • Fax: 760-773-9294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA121367
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: