Provider Demographics
NPI:1558654939
Name:CIELAK, CAROLINA (PA)
Entity Type:Individual
Prefix:MS
First Name:CAROLINA
Middle Name:
Last Name:CIELAK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CAROLINA
Other - Middle Name:
Other - Last Name:ALEJANDRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1715 MCCULLOUGH AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-4046
Mailing Address - Country:US
Mailing Address - Phone:210-732-3668
Mailing Address - Fax:210-732-3338
Practice Address - Street 1:1715 MCCULLOUGH AVE FL 2
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4046
Practice Address - Country:US
Practice Address - Phone:210-732-3668
Practice Address - Fax:210-732-3338
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07130363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant