Healthcare Provider Details

I. General information

NPI: 1972392165
Provider Name (Legal Business Name): EDUINA CUELLAR LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 05/05/2025
Certification Date: 05/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2435 S TELSHOR BLVD
LAS CRUCES NM
88011-5029
US

IV. Provider business mailing address

5291 SIOUX TRL
LAS CRUCES NM
88012-7366
US

V. Phone/Fax

Practice location:
  • Phone: 575-621-0106
  • Fax:
Mailing address:
  • Phone: 575-621-0106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-2024-0230
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: