Provider Demographics
NPI:1376309864
Name:CUELLAR, WILLIAM PETE
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:PETE
Last Name:CUELLAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ROSSFORD
Mailing Address - State:OH
Mailing Address - Zip Code:43460-1002
Mailing Address - Country:US
Mailing Address - Phone:949-226-3841
Mailing Address - Fax:
Practice Address - Street 1:448 HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:ROSSFORD
Practice Address - State:OH
Practice Address - Zip Code:43460-1002
Practice Address - Country:US
Practice Address - Phone:949-226-3841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide