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General NPI Number Information
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NPI Number | 1932554383
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Entity Type | Organization
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Legal Business Name | JASON M. CUELLAR, M.D., INC.
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Dates
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Enumeration Date | 05/03/2016
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Last Update Date | 06/20/2016
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Provider Practice Location Address
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Address Line | 450 N ROXBURY DR FL 3
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-4238
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Country | US
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Telephone | 310-385-7766
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Fax |
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Provider Business Mailing Address
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Address Line | 450 N ROXBURY DR FL 3
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-4238
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Country | US
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Telephone | 310-385-7766
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND SECRETARY
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Name | DR. JASON M CUELLAR
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Credential | M.D.
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Telephone | 917-744-9052
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | A135554
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License Number State | CA
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