Healthcare Provider Details

I. General information

NPI: 1487438917
Provider Name (Legal Business Name): ISABEL CUELLAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 TECHNOLOGY CT STE 101
RIVERSIDE CA
92507-2181
US

IV. Provider business mailing address

525 TECHNOLOGY CT STE 101
RIVERSIDE CA
92507-2181
US

V. Phone/Fax

Practice location:
  • Phone: 949-309-1378
  • Fax: 844-548-0616
Mailing address:
  • Phone: 949-309-1378
  • Fax: 844-548-0616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: