Healthcare Provider Details

I. General information

NPI: 1851268866
Provider Name (Legal Business Name): JONATHAN A CUELLAR SOTO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2025
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 N 4TH ST
SAN JOSE CA
95112-4713
US

IV. Provider business mailing address

30 NEWELL RD APT 8
EAST PALO ALTO CA
94303-2748
US

V. Phone/Fax

Practice location:
  • Phone: 877-722-2737
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: