Provider Demographics
NPI:1801890157
Name:CUELLAR, RICARDO LUIS (MD)
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:LUIS
Last Name:CUELLAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31109 KNOTTY GRV
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS RANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78015-4305
Mailing Address - Country:US
Mailing Address - Phone:210-977-9080
Mailing Address - Fax:
Practice Address - Street 1:7430 BARLITE BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-1365
Practice Address - Country:US
Practice Address - Phone:210-977-9080
Practice Address - Fax:210-977-8480
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6336208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158120904Medicaid
TX8J2186Medicare PIN
TXH89235Medicare UPIN