Healthcare Provider Details

I. General information

NPI: 1093097909
Provider Name (Legal Business Name): ROSALINDA CUELLAR FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 03/28/2020
Certification Date: 03/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 GALVESTON ST
LAREDO TX
78043-2909
US

IV. Provider business mailing address

2603 N ARKANSAS AVE STE C
LAREDO TX
78043-2202
US

V. Phone/Fax

Practice location:
  • Phone: 956-206-4366
  • Fax:
Mailing address:
  • Phone: 956-568-5394
  • Fax: 956-568-3294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number618042
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: