Healthcare Provider Details

I. General information

NPI: 1770059578
Provider Name (Legal Business Name): REBECCA CUELLAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2018
Last Update Date: 10/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 E HORIZON DR STE H
HENDERSON NV
89015-8001
US

IV. Provider business mailing address

220 E HORIZON DR STE H
HENDERSON NV
89015-8001
US

V. Phone/Fax

Practice location:
  • Phone: 702-577-5977
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: