Healthcare Provider Details

I. General information

NPI: 1053111617
Provider Name (Legal Business Name): DANIEL ALEJANDRO CUELLAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1627 HOLLYHOCK RD
WELLINGTON FL
33414-8626
US

IV. Provider business mailing address

1627 HOLLYHOCK RD
WELLINGTON FL
33414-8626
US

V. Phone/Fax

Practice location:
  • Phone: 561-379-2958
  • Fax:
Mailing address:
  • Phone: 561-379-2958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-355113
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: