Healthcare Provider Details

I. General information

NPI: 1578993002
Provider Name (Legal Business Name): MCLAIN MALLORY CUELLAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2013
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 S JACKSON RD STE 4
MCALLEN TX
78503-1589
US

IV. Provider business mailing address

1900 S JACKSON RD STE 4
MCALLEN TX
78503-1589
US

V. Phone/Fax

Practice location:
  • Phone: 956-971-9930
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number2635
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: