Healthcare Provider Details

I. General information

NPI: 1881401776
Provider Name (Legal Business Name): LINDA CUELLAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2024
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7160 RAFAEL RIVVERA WAY SUITW 110 110
LAS VEGAS NV
89113
US

IV. Provider business mailing address

7160 RAFAEL RIVERA WAY STE 110
LAS VEGAS NV
89113-5394
US

V. Phone/Fax

Practice location:
  • Phone: 702-850-2691
  • Fax:
Mailing address:
  • Phone: 702-850-2691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: