Provider Demographics
NPI:1841984259
Name:CUELLAR, AIMEE NICOLE
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:NICOLE
Last Name:CUELLAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3576 ARLINGTON AVE
Mailing Address - Street 2:ST 100
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506
Mailing Address - Country:US
Mailing Address - Phone:951-374-1555
Mailing Address - Fax:951-394-7426
Practice Address - Street 1:3576 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3943
Practice Address - Country:US
Practice Address - Phone:951-374-1555
Practice Address - Fax:951-394-7426
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA150216106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program