Provider Demographics
NPI:1932640513
Name:CUELLAR, CASSANDRA PAULINE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:PAULINE
Last Name:CUELLAR
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5429 N 23RD ST STE C
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-4193
Mailing Address - Country:US
Mailing Address - Phone:956-477-1463
Mailing Address - Fax:956-446-1606
Practice Address - Street 1:5429 N 23RD ST STE C
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-4193
Practice Address - Country:US
Practice Address - Phone:956-477-1463
Practice Address - Fax:956-446-1606
Is Sole Proprietor?:No
Enumeration Date:2017-03-15
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA11158363A00000X, 363AM0700X
TX11158363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant