Provider Demographics
NPI:1487341376
Name:CUELLAR, ROXANA ELIZABETH (MS)
Entity type:Individual
Prefix:
First Name:ROXANA
Middle Name:ELIZABETH
Last Name:CUELLAR
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8323 PURITAN ST
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-4451
Mailing Address - Country:US
Mailing Address - Phone:213-379-2511
Mailing Address - Fax:
Practice Address - Street 1:8300 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-3493
Practice Address - Country:US
Practice Address - Phone:213-219-1332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT134879106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist