Provider Demographics
NPI:1285452318
Name:CISTOLA, DAVID PAUL (MD, PHD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:PAUL
Last Name:CISTOLA
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 VIA APPIA ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-6628
Mailing Address - Country:US
Mailing Address - Phone:314-602-9868
Mailing Address - Fax:
Practice Address - Street 1:5130 GATEWAY BLVD E STE 321
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-1608
Practice Address - Country:US
Practice Address - Phone:314-602-9868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician