Basic Information
| Provider Information | |||||||||
| NPI: | 1063804672 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ERIVEZ | ||||||||
| FirstName: | JIMMY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1404 S NEW RD | ||||||||
| Address2: | |||||||||
| City: | WACO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 767111335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2545374422 | ||||||||
| FaxNumber: | 2543004619 | ||||||||
| Practice Location | |||||||||
| Address1: | 750 SUNLAND PARK DR | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799126709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9157608830 | ||||||||
| FaxNumber: | 9157608840 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2015 | ||||||||
| LastUpdateDate: | 02/19/2015 | ||||||||
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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 | 237700000X | 80268 | TX | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.