MEDICARE: RICARDO LUIS CUELLAR M.D.

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	208000000X	Pediatrics Physician	L6336	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801890157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICARDO LUIS CUELLAR M.D.

Provider Business Mailing Address
First Line	:	31109 KNOTTY GRV
Second Line	:
City	:	FAIR OAKS RANCH
State	:	TX
Zip	:	78015-4305
Country	:	US
Telephone Number	:	210-977-9080
Fax Number	:

Provider Business Practice Location Address
First Line	:	7430 BARLITE BLVD
Second Line	:	SUITE 104
City	:	SAN ANTONIO
State	:	TX
Zip	:	78224-1365
Country	:	US
Telephone Number	:	210-977-9080
Fax Number	:	210-977-8480

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	05/26/2011

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