Provider Demographics
NPI:1093831117
Name:CUELLAR, CARLOS A (PA-C)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:A
Last Name:CUELLAR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 DONNER LN
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-4167
Mailing Address - Country:US
Mailing Address - Phone:530-894-7354
Mailing Address - Fax:530-898-6647
Practice Address - Street 1:STUDENT HEALTH SERVICES CSU CHICO
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95929-0001
Practice Address - Country:US
Practice Address - Phone:530-898-5241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12339363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical