Healthcare Provider Details

I. General information

NPI: 1164005997
Provider Name (Legal Business Name): WALDO L CUELLAR DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 JOE BATTLE BLVD
EL PASO TX
79938-2622
US

IV. Provider business mailing address

2930 N STANTON ST
EL PASO TX
79902-2511
US

V. Phone/Fax

Practice location:
  • Phone: 915-271-4570
  • Fax: 915-351-0076
Mailing address:
  • Phone: 915-271-4570
  • Fax: 915-351-0076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberV9876
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: