1801890157 NPI number — RICARDO LUIS CUELLAR M.D.

Table of content: RICARDO LUIS CUELLAR M.D. (NPI 1801890157)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801890157 NPI number — RICARDO LUIS CUELLAR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUELLAR
Provider First Name:
RICARDO
Provider Middle Name:
LUIS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801890157
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7430 BARLITE BLVD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78224-1365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-977-9080
Provider Business Practice Location Address Fax Number:
210-977-8480
Provider Enumeration Date:
06/01/2005

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  L6336 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 158120904 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com