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General NPI Number Information
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NPI Number | 1285072777
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Entity Type | Individual
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Provider Name | IVETH CUELLAR CELALLOS
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Gender | Female
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Dates
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Enumeration Date | 06/06/2013
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Last Update Date | 08/23/2021
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Provider Practice Location Address
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Address Line | 1001 POTRERO AVE # 6B
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City | SAN FRANCISCO
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State | CA
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Zip | 94110-3518
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Country | US
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Telephone | 628-206-4444
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Fax |
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Provider Business Mailing Address
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Address Line | 802 BREWSTER AVENUE
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City | REDWOOD CITY
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State | CA
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Zip | 94063
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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