Basic Information
| Provider Information | |||||||||
| NPI: | 1053355313 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RANGEL | ||||||||
| FirstName: | LIONEL | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1626 MEDICAL CENTER DR STE 400 | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799025000 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1626 MEDICAL CENTER DR STE 400 | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799025000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155469200 | ||||||||
| FaxNumber: | 9155469800 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 04/13/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | L1712 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 55438563 | 05 | NM | MEDICAID | 143585103 | 05 | TX | MEDICAID | 143585104 | 05 | TX | MEDICAID |