Healthcare Provider Details

I. General information

NPI: 1952865115
Provider Name (Legal Business Name): JISELLE DEL CID
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2019
Last Update Date: 06/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10301 GATEWAY BLVD W
EL PASO TX
79925-7701
US

IV. Provider business mailing address

6028 SURETY DR
EL PASO TX
79905-2018
US

V. Phone/Fax

Practice location:
  • Phone: 915-208-0281
  • Fax:
Mailing address:
  • Phone: 915-544-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA12620
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: