Provider Demographics
NPI: | 1114259462 |
---|---|
Name: | CUELLAR - SAENZ, HUGO HUMBERTO (MD) |
Entity type: | Individual |
Prefix: | |
First Name: | HUGO |
Middle Name: | HUMBERTO |
Last Name: | CUELLAR - SAENZ |
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: | 1501 KINGS HWY |
Mailing Address - Street 2: | DEPARTMENT OF NEUROSURGERY |
Mailing Address - City: | SHREVEPORT |
Mailing Address - State: | LA |
Mailing Address - Zip Code: | 71103-4228 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 318-675-6404 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1501 KINGS HWY |
Practice Address - Street 2: | DEPARTMENT OF NEUROSURGERY |
Practice Address - City: | SHREVEPORT |
Practice Address - State: | LA |
Practice Address - Zip Code: | 71103-4228 |
Practice Address - Country: | US |
Practice Address - Phone: | 318-675-6404 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2010-02-10 |
Last Update Date: | 2010-03-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
LA | 203541 | 207T00000X, 2085N0700X, 2085R0204X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2085R0204X | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | |
No | 2085N0700X | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology |