Provider Demographics
NPI:1003388406
Name:ALEMAN, GUSTAVO ALCANTAR JR (PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:GUSTAVO
Middle Name:ALCANTAR
Last Name:ALEMAN
Suffix:JR
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2815 TOLAR STREET
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:76384
Mailing Address - Country:US
Mailing Address - Phone:214-632-7574
Mailing Address - Fax:
Practice Address - Street 1:4730 COLLEGE DRIVE
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:TX
Practice Address - Zip Code:76384
Practice Address - Country:US
Practice Address - Phone:940-552-9901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-23
Last Update Date:2018-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139970363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health