Provider Demographics
NPI:1255063673
Name:CUELLAR, FABIOLA FERNANDA
Entity type:Individual
Prefix:
First Name:FABIOLA
Middle Name:FERNANDA
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 1:304 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS FRESNOS
Mailing Address - State:TX
Mailing Address - Zip Code:78566-3313
Mailing Address - Country:US
Mailing Address - Phone:210-956-7089
Mailing Address - Fax:
Practice Address - Street 1:1205 N RAUL LONGORIA RD STE I
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-3721
Practice Address - Country:US
Practice Address - Phone:956-782-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-24
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118781235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist