Provider Demographics
NPI:1023443363
Name:CUELLO, EZEQUIEL (RN)
Entity type:Individual
Prefix:
First Name:EZEQUIEL
Middle Name:
Last Name:CUELLO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3496 SW 24TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-3029
Mailing Address - Country:US
Mailing Address - Phone:305-401-1778
Mailing Address - Fax:
Practice Address - Street 1:2001 NW 7TH ST
Practice Address - Street 2:STE # 104
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3479
Practice Address - Country:US
Practice Address - Phone:305-640-5065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 9238000163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse