Healthcare Provider Details

I. General information

NPI: 1104307370
Provider Name (Legal Business Name): CUELLO MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 10/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10201 HAMMOCKS BLVD STE 123
MIAMI FL
33196-3783
US

IV. Provider business mailing address

2921 SW 8TH ST
MIAMI FL
33135-2826
US

V. Phone/Fax

Practice location:
  • Phone: 305-279-7020
  • Fax: 305-598-8089
Mailing address:
  • Phone: 305-532-9926
  • Fax: 305-570-2060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberME00449683
License Number StateFL

VIII. Authorized Official

Name: STEPHANY GUZMAN
Title or Position: BILLING DIRECTOR
Credential:
Phone: 305-532-9926