Provider Demographics
NPI:1780171207
Name:CUELLAR, VICTOR A (LPN)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:A
Last Name:CUELLAR
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1652 SE 28TH ST UNIT 204
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33035-2513
Mailing Address - Country:US
Mailing Address - Phone:305-992-8796
Mailing Address - Fax:
Practice Address - Street 1:1652 SE 28TH ST UNIT 204
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33035-2513
Practice Address - Country:US
Practice Address - Phone:305-992-8796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5232804164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse