Healthcare Provider Details

I. General information

NPI: 1760987952
Provider Name (Legal Business Name): YURI EDGARDO CUELLAR DE LA CRUZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4702 S MCCOLL RD
EDINBURG TX
78539-8201
US

IV. Provider business mailing address

301 W EXPY 83
MCALLEN TX
78503-3045
US

V. Phone/Fax

Practice location:
  • Phone: 956-213-2600
  • Fax:
Mailing address:
  • Phone: 956-632-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberT3063
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: