Provider Demographics
NPI:1689189870
Name:ANELLO, ALEXIS RE (CST, CSFA, LSA)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:RE
Last Name:ANELLO
Suffix:
Gender:F
Credentials:CST, CSFA, LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4875 KENNEDALE NEW HOPE RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76140-7813
Mailing Address - Country:US
Mailing Address - Phone:940-390-1463
Mailing Address - Fax:
Practice Address - Street 1:4875 KENNEDALE NEW HOPE RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76140-7813
Practice Address - Country:US
Practice Address - Phone:940-390-1463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-09
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00648246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant