Provider Demographics
NPI:1275391906
Name:CUELLAR, JONATHAN (CRNA)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:CUELLAR
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4116 TYLER AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-8227
Mailing Address - Country:US
Mailing Address - Phone:956-212-9902
Mailing Address - Fax:
Practice Address - Street 1:4116 TYLER AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-8227
Practice Address - Country:US
Practice Address - Phone:956-212-9902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1154779367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered