Healthcare Provider Details

I. General information

NPI: 1467239137
Provider Name (Legal Business Name): CYNTHIA VICTORIA CUELLAR AJANEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2023
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 COLE ST
SAN FRANCISCO CA
94117-2805
US

IV. Provider business mailing address

555 COLE ST
SAN FRANCISCO CA
94117-2805
US

V. Phone/Fax

Practice location:
  • Phone: 415-386-9398
  • Fax:
Mailing address:
  • Phone: 323-507-7986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number120201
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: