Provider Demographics
NPI:1750568523
Name:MARTINEZ-CUELLAR, JORGE ENRIQUE (MD)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:ENRIQUE
Last Name:MARTINEZ-CUELLAR
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 1:1160 E PERRIN AVE
Mailing Address - Street 2:APT 108
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-4262
Mailing Address - Country:US
Mailing Address - Phone:773-816-4136
Mailing Address - Fax:
Practice Address - Street 1:1180 E SHAW AVE
Practice Address - Street 2:SUITE 125
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7812
Practice Address - Country:US
Practice Address - Phone:559-228-4245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-23
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA105687207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine