Healthcare Provider Details

I. General information

NPI: 1093261604
Provider Name (Legal Business Name): JULIO ALCALA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10291 PELLICANO SUITE 102
EL PASO TX
79935
US

IV. Provider business mailing address

12148 SAINT JUDE AVE
EL PASO TX
79936-0321
US

V. Phone/Fax

Practice location:
  • Phone: 915-613-2748
  • Fax: 915-845-9753
Mailing address:
  • Phone: 915-422-8684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License NumberGMR00091707
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: