Healthcare Provider Details

I. General information

NPI: 1518442375
Provider Name (Legal Business Name): ALEXI CUELLAR GUERRERO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2018
Last Update Date: 07/05/2021
Certification Date: 07/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3580 LAKE WORTH RD
PALM SPRINGS FL
33461-4029
US

IV. Provider business mailing address

115 MEADOWLARK DR
ROYAL PALM BEACH FL
33411-2968
US

V. Phone/Fax

Practice location:
  • Phone: 561-425-5075
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9423768
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9423768
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: