Healthcare Provider Details

I. General information

NPI: 1609531771
Provider Name (Legal Business Name): RACHEL GEORGINA CUELLAR M.A.,CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2021
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7710 PANDORA ST
EL PASO TX
79904-3827
US

IV. Provider business mailing address

3700 THOMASON AVE
EL PASO TX
79904-6144
US

V. Phone/Fax

Practice location:
  • Phone: 915-236-5675
  • Fax: 915-759-8115
Mailing address:
  • Phone: 915-230-2000
  • Fax: 915-759-8115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number101888
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: