Healthcare Provider Details

I. General information

NPI: 1174365506
Provider Name (Legal Business Name): DANA M CUELLO BLANCO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2024
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 KM 141.1
AGUADILLA PR
00603
US

IV. Provider business mailing address

VILLAS DE PALMA REAL HC9 BOX 11963
AGUADILLA PR
00603-9320
US

V. Phone/Fax

Practice location:
  • Phone: 787-309-9561
  • Fax:
Mailing address:
  • Phone: 787-309-9561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number24656
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: