Healthcare Provider Details

I. General information

NPI: 1285452318
Provider Name (Legal Business Name): DAVID PAUL CISTOLA MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2024
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5130 GATEWAY BLVD E STE 321
EL PASO TX
79905-1608
US

IV. Provider business mailing address

1501 VIA APPIA ST
EL PASO TX
79912-6628
US

V. Phone/Fax

Practice location:
  • Phone: 314-602-9868
  • Fax:
Mailing address:
  • Phone: 314-602-9868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: