Provider Demographics
NPI:1942759154
Name:VANESSA GABROVSKY CUELLAR MD INC
Entity type:Organization
Organization Name:VANESSA GABROVSKY CUELLAR MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:GABROVSKY
Authorized Official - Last Name:CUELLAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-744-7591
Mailing Address - Street 1:450 N ROXBURY DR
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4231
Mailing Address - Country:US
Mailing Address - Phone:310-385-7766
Mailing Address - Fax:
Practice Address - Street 1:450 N ROXBURY DR
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4231
Practice Address - Country:US
Practice Address - Phone:310-385-7766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA134536261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical