Healthcare Provider Details

I. General information

NPI: 1932120623
Provider Name (Legal Business Name): BEATRIZ CUELLO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 HOSPITAL AVE
DANBURY CT
06810-6099
US

IV. Provider business mailing address

24 HOSPITAL AVE
DANBURY CT
06810-6099
US

V. Phone/Fax

Practice location:
  • Phone: 203-797-7306
  • Fax:
Mailing address:
  • Phone: 203-797-7306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number019635
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: