Provider Demographics
NPI:1013209394
Name:PUELLO, CESAR (LAC)
Entity Type:Individual
Prefix:MR
First Name:CESAR
Middle Name:
Last Name:PUELLO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 15TH ST
Mailing Address - Street 2:#4R
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-5771
Mailing Address - Country:US
Mailing Address - Phone:917-816-4570
Mailing Address - Fax:
Practice Address - Street 1:80 EAST 11TH ST
Practice Address - Street 2:ROOM 421
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-6811
Practice Address - Country:US
Practice Address - Phone:917-816-4570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-05
Last Update Date:2015-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001506171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist