Healthcare Provider Details

I. General information

NPI: 1003855511
Provider Name (Legal Business Name): JORGE LUIS CUELLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 SUNSET DR SUITE 401
SOUTH MIAMI FL
33143-4828
US

IV. Provider business mailing address

6200 SUNSET DR SUITE 401
SOUTH MIAMI FL
33143-4828
US

V. Phone/Fax

Practice location:
  • Phone: 305-666-4633
  • Fax: 305-487-3323
Mailing address:
  • Phone: 305-666-4633
  • Fax: 305-487-3323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME0070399
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME0070399
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: