Provider Demographics
NPI:1134389182
Name:CUELLAR, ESTELA H (FNP)
Entity type:Individual
Prefix:
First Name:ESTELA
Middle Name:H
Last Name:CUELLAR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2065 KEYSTONE PACIFIC PKWY
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:CA
Mailing Address - Zip Code:95363-8865
Mailing Address - Country:US
Mailing Address - Phone:209-895-4712
Mailing Address - Fax:209-895-4721
Practice Address - Street 1:2065 KEYSTONE PACIFIC PKWY
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:CA
Practice Address - Zip Code:95363-8865
Practice Address - Country:US
Practice Address - Phone:209-895-4712
Practice Address - Fax:209-895-4721
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA475186364SW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1417930892Medicaid