Healthcare Provider Details

I. General information

NPI: 1316783129
Provider Name (Legal Business Name): LORRAINE BRIDGET CUELLAR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8265 W 2700 S
MAGNA UT
84044-1323
US

IV. Provider business mailing address

5632 W 8090 S APT B308
WEST JORDAN UT
84081-5950
US

V. Phone/Fax

Practice location:
  • Phone: 310-497-5294
  • Fax:
Mailing address:
  • Phone: 310-497-5294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9145002-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: