Individual
DENISE REBECCA CUBILLOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSA
Contact information
Practice address
3007 KILLARNEY ST, EL PASO, TX 79925-4170
(915) 203-7894
Mailing address
8900 VISCOUNT, PMB213, EL PASO, TX 79925
(915) 203-7894
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
SA00116
TX
363AS0400X
Surgical Physician Assistant
Primary
SA00116
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0083JR
BCBS
TX
01
—
142239400
US DEPT OF LABOR
TX
Enumeration date
01/30/2007
Last updated
11/05/2020
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