Organization
KIDNEYSPA IN-HOME DIALYSIS SE TEXAS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUAN M CUELLAR MD (MEMBER)
(305) 329-2900
Entity
Organization
Contact information
Practice address
7102 BROOKSIDE RD, PEARLAND, TX 77581-7323
(832) 352-4277
Mailing address
219 NW 12TH AVE APT 508, MIAMI, FL 33128-2206
(305) 329-2900
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
251F00000X
Home Infusion Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BD1200X
Dialysis Equipment & Supplies (DME)
—
—
Other
Enumeration date
12/13/2021
Last updated
10/17/2023
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