Healthcare Provider Details

I. General information

NPI: 1457960122
Provider Name (Legal Business Name): JACLYN GRACE GELABERT PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 N OREGON ST
EL PASO TX
79902-3170
US

IV. Provider business mailing address

125 W HAGUE RD STE 180
EL PASO TX
79902-5811
US

V. Phone/Fax

Practice location:
  • Phone: 915-317-1660
  • Fax:
Mailing address:
  • Phone: 915-317-1660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: