Provider Demographics
NPI:1437758216
Name:CUELLAR GUTIERRES, AIDEE
Entity Type:Individual
Prefix:
First Name:AIDEE
Middle Name:
Last Name:CUELLAR GUTIERRES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10231 NW 129TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-6001
Mailing Address - Country:US
Mailing Address - Phone:786-800-1399
Mailing Address - Fax:
Practice Address - Street 1:10231 NW 129TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-6001
Practice Address - Country:US
Practice Address - Phone:786-800-1399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician