MEDICARE: SERENA LAWRENCE CUELLAR MD

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	390200000X	Student in an Organized Health Care Education/Training Program	BP10068874	TX
2	207Q00000X	Family Medicine Physician	T7524	TX

General Provider Information

NPI Number	:	1811554108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SERENA LAWRENCE CUELLAR MD

Provider Business Mailing Address
First Line	:	11130 CHRISTUS HILLS
Second Line	:	MEDICAL PLAZA 3, 3RD FL
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-3585
Country	:	US
Telephone Number	:	210-703-9001
Fax Number	:	210-703-9155

Provider Business Practice Location Address
First Line	:	11130 CHRISTUS HILLS
Second Line	:	MEDICAL PLAZA 3, 3RD FL
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-3585
Country	:	US
Telephone Number	:	210-703-9001
Fax Number	:	210-703-9155

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

Provider Enumeration Date	:	05/22/2019
Last Update Date	:	06/21/2022

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