Provider Demographics
NPI:1811554108
Name:CUELLAR, SERENA LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:SERENA
Middle Name:LAWRENCE
Last Name:CUELLAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SERENA
Other - Middle Name:LAWRENCE
Other - Last Name:MCGILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11130 CHRISTUS HILLS
Mailing Address - Street 2:MEDICAL PLAZA 3, 3RD FL
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-3585
Mailing Address - Country:US
Mailing Address - Phone:210-703-9001
Mailing Address - Fax:210-703-9155
Practice Address - Street 1:11130 CHRISTUS HILLS
Practice Address - Street 2:MEDICAL PLAZA 3, 3RD FL
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-3585
Practice Address - Country:US
Practice Address - Phone:210-703-9001
Practice Address - Fax:210-703-9155
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10068874390200000X
TXT7524207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program