Provider Demographics
NPI:1598376394
Name:CUELLO, ALEC GERARD (PA)
Entity Type:Individual
Prefix:
First Name:ALEC
Middle Name:GERARD
Last Name:CUELLO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S MESA HILLS DR APT 1317
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5483
Mailing Address - Country:US
Mailing Address - Phone:210-219-2431
Mailing Address - Fax:
Practice Address - Street 1:3600 N GARFIELD ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-6329
Practice Address - Country:US
Practice Address - Phone:210-219-2431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-14
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA15150363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant