Healthcare Provider Details

I. General information

NPI: 1730929266
Provider Name (Legal Business Name): DEYANIRA CUELLAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2024
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3315 BURKE RD STE 201
PASADENA TX
77504-1823
US

IV. Provider business mailing address

11728 JELICOE DR
HOUSTON TX
77047-3520
US

V. Phone/Fax

Practice location:
  • Phone: 713-944-2324
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1164305
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: