Healthcare Provider Details

I. General information

NPI: 1932640513
Provider Name (Legal Business Name): CASSANDRA PAULINE CUELLAR PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2017
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5429 N 23RD ST STE C
MCALLEN TX
78504-4193
US

IV. Provider business mailing address

5429 N 23RD ST STE C
MCALLEN TX
78504-4193
US

V. Phone/Fax

Practice location:
  • Phone: 956-477-1463
  • Fax: 956-446-1606
Mailing address:
  • Phone: 956-477-1463
  • Fax: 956-446-1606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA11158
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: