Provider Demographics
NPI:1831899582
Name:CUELLAR, JEREMY NICHOLAS (CPT)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:NICHOLAS
Last Name:CUELLAR
Suffix:
Gender:M
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23635 WILDERNESS OAK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3570
Mailing Address - Country:US
Mailing Address - Phone:210-490-2677
Mailing Address - Fax:866-595-1374
Practice Address - Street 1:23635 WILDERNESS OAK
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3570
Practice Address - Country:US
Practice Address - Phone:210-490-2677
Practice Address - Fax:866-595-1374
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225955183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician