MEDICARE: DEYANIRA CUELLAR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1164305	TX

General Provider Information

NPI Number	:	1730929266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEYANIRA CUELLAR

Provider Business Mailing Address
First Line	:	11728 JELICOE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77047-3520
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3315 BURKE RD STE 201
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77504-1823
Country	:	US
Telephone Number	:	713-944-2324
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2024
Last Update Date	:	07/23/2024

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Directions to “ DEYANIRA CUELLAR ” Practice Location

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