Healthcare Provider Details

I. General information

NPI: 1992863328
Provider Name (Legal Business Name): RAFAEL E CUELLAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 12/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2341 S MELROSE DR
VISTA CA
92081-8788
US

IV. Provider business mailing address

2341 S MELROSE DR
VISTA CA
92081-8788
US

V. Phone/Fax

Practice location:
  • Phone: 760-599-1222
  • Fax: 760-599-1221
Mailing address:
  • Phone: 760-599-1222
  • Fax: 760-599-1221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA42213
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: