Healthcare Provider Details

I. General information

NPI: 1275391906
Provider Name (Legal Business Name): JONATHAN CUELLAR CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4116 TYLER AVE
MCALLEN TX
78503-8227
US

IV. Provider business mailing address

4116 TYLER AVE
MCALLEN TX
78503-8227
US

V. Phone/Fax

Practice location:
  • Phone: 956-212-9902
  • Fax:
Mailing address:
  • Phone: 956-212-9902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1154779
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: