Healthcare Provider Details

I. General information

NPI: 1063851517
Provider Name (Legal Business Name): REBECCA ELIZABETH CUELLO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA ELIZABETH HOLDER D.O.

II. Dates (important events)

Enumeration Date: 06/18/2013
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 RAND BLVD
SARASOTA FL
34238-5160
US

IV. Provider business mailing address

1001 20TH ST W
BRADENTON FL
34205-5352
US

V. Phone/Fax

Practice location:
  • Phone: 727-698-9365
  • Fax:
Mailing address:
  • Phone: 719-252-5834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS20829
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDR.0057350
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: