Provider Demographics
NPI:1053320861
Name:CUELLAR, MARTA LUCIA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTA
Middle Name:LUCIA
Last Name:CUELLAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2134 VILLA WAY
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32169-2069
Mailing Address - Country:US
Mailing Address - Phone:386-427-9650
Mailing Address - Fax:
Practice Address - Street 1:100 NW 170TH ST
Practice Address - Street 2:SUITE # 410
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33169-5513
Practice Address - Country:US
Practice Address - Phone:305-654-6850
Practice Address - Fax:305-654-6858
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 96445207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1483761Medicaid
FL1483761Medicaid
FLAB002XMedicare UPIN