Basic Information
| Provider Information | |||||||||
| NPI: | 1063777019 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EL PASO CENTER FOR FAMILY & SPORTS MEDICINE PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5959 GATEWAY BLVD W STE 120 | ||||||||
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| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799253315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9157791716 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1600 N LEE TREVINO DR | ||||||||
| Address2: | SUITE D3 | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799365169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9154936646 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2012 | ||||||||
| LastUpdateDate: | 09/17/2012 | ||||||||
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| AuthorizedOfficialLastName: | GARCIA | ||||||||
| AuthorizedOfficialFirstName: | ANGEL | ||||||||
| AuthorizedOfficialMiddleName: | JOEL | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9154497200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QS0010X | N9857 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
No ID Information.