Healthcare Provider Details

I. General information

NPI: 1427616127
Provider Name (Legal Business Name): VICTOR CUELLAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2019
Last Update Date: 05/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9616 N LAMAR BLVD STE 105
AUSTIN TX
78753-4163
US

IV. Provider business mailing address

305 NE LOOP 820 BUSINESS TOWER 1 SUITE 200
HURST TX
76053
US

V. Phone/Fax

Practice location:
  • Phone: 512-527-9608
  • Fax:
Mailing address:
  • Phone: 817-292-8787
  • Fax: 817-789-6849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: