Healthcare Provider Details

I. General information

NPI: 1598376394
Provider Name (Legal Business Name): ALEC GERARD CUELLO PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2020
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 N GARFIELD ST
MIDLAND TX
79705-6329
US

IV. Provider business mailing address

415 S MESA HILLS DR APT 1317
EL PASO TX
79912-5483
US

V. Phone/Fax

Practice location:
  • Phone: 210-219-2431
  • Fax:
Mailing address:
  • Phone: 210-219-2431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA15150
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: