Healthcare Provider Details

I. General information

NPI: 1609449347
Provider Name (Legal Business Name): DENYS ALEJANDRA CUELLAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99-370 MOANALUA RD
AIEA HI
96701-3632
US

IV. Provider business mailing address

1212 LUNALILO ST APT 201
HONOLULU HI
96822-4001
US

V. Phone/Fax

Practice location:
  • Phone: 808-305-4400
  • Fax:
Mailing address:
  • Phone: 909-489-9821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number20133781
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: