Provider Demographics
NPI:1104098433
Name:SANDRA E CUELLAR DPM , P.C.
Entity type:Organization
Organization Name:SANDRA E CUELLAR DPM , P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:E
Authorized Official - Last Name:CUELLAR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:972-991-1700
Mailing Address - Street 1:5925 FOREST LN
Mailing Address - Street 2:#116
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2712
Mailing Address - Country:US
Mailing Address - Phone:972-991-1700
Mailing Address - Fax:800-559-3847
Practice Address - Street 1:5925 FOREST LN
Practice Address - Street 2:#116
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2712
Practice Address - Country:US
Practice Address - Phone:972-991-1700
Practice Address - Fax:800-559-3847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2009-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1055213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018650401Medicaid
TXT87030OtherUPIN
0821860001Medicare NSC
TXT87030OtherUPIN