Healthcare Provider Details

I. General information

NPI: 1093462954
Provider Name (Legal Business Name): ALEXANDER CUELLAR MS, OT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2022
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2504 E GRIFFIN PKWY
MISSION TX
78572-3348
US

IV. Provider business mailing address

2504 E GRIFFIN PKWY
MISSION TX
78572-3348
US

V. Phone/Fax

Practice location:
  • Phone: 956-227-2110
  • Fax:
Mailing address:
  • Phone: 956-227-2110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number122305
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: