1710968714 NPI number — ALBERTO D CUELLAR MD

Employer Identification Number (EIN)	:
Provider Organization Name (Legal Business Name)	:
Provider Last Name (Legal Name)	:	CUELLAR
Provider First Name	:	ALBERTO
Provider Middle Name	:	D
Provider Name Prefix Text	:
Provider Name Suffix Text	:
Provider Credential Text	:	MD
Provider Gender Code	:	M

Provider Other Organization Name	:
Provider Other Organization Name Type Code	:
Provider Other Last Name	:	CUELLAR
Provider Other First Name	:	ALBERT
Provider Other Middle Name	:	D
Provider Other Name Prefix Text	:
Provider Other Name Suffix Text	:
Provider Other Credential Text	:
Provider Other Last Name Type Code	:	2

NPI Number	:	1710968714
Entity Type Code	:	Individual
Replacement NPI	:
Last Update Date	:	05/07/2009
NPI Deactivation Reason Code	:
NPI Deactivation Date	:
NPI Reactivation Date	:

Provider First Line Business Mailing Address	:	PO BOX 4356
Provider Second Line Business Mailing Address	:	DEPT 665
Provider Business Mailing Address City Name	:	HOUSTON
Provider Business Mailing Address State Name	:	TX
Provider Business Mailing Address Postal Code	:	772104356
Provider Business Mailing Address Country Code	:	US
Provider Business Mailing Address Telephone Number	:	2814406960
Provider Business Mailing Address Fax Number	:	2818801566

Provider First Line Business Practice Location Address	:	17270 RED OAK DR
Provider Second Line Business Practice Location Address	:	STE 200
Provider Business Practice Location Address City Name	:	HOUSTON
Provider Business Practice Location Address State Name	:	TX
Provider Business Practice Location Address Postal Code	:	770902618
Provider Business Practice Location Address Country Code	:	US
Provider Business Practice Location Address Telephone Number	:	2814406960
Provider Business Practice Location Address Fax Number	:	2814406205
Provider Enumeration Date	:	11/08/2005

Authorized Official Last Name	:
Authorized Official First Name	:
Authorized Official Middle Name	:
Authorized Official Title or Position	:
Authorized Official Telephone Number	:

• Taxonomy code: 207XS0114X , with the licence number:  G8816 , registered in the state of TX .
• Taxonomy code: 207X00000X , with the licence number: G88816 , registered in the state of TX .