Healthcare Provider Details

I. General information

NPI: 1922662386
Provider Name (Legal Business Name): JORGE CUELLAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2019
Last Update Date: 04/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 S CYNTHIA ST
MCALLEN TX
78501-1153
US

IV. Provider business mailing address

1209 S 10TH ST STE A380
MCALLEN TX
78501-5059
US

V. Phone/Fax

Practice location:
  • Phone: 956-655-7954
  • Fax:
Mailing address:
  • Phone: 956-655-7954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: