Basic Information
Provider Information | |||||||||
NPI: | 1346777190 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | DIAGNOSTIC PRO IMAGING | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 6501 N MESA ST | ||||||||
Address2: | SUITE A | ||||||||
City: | EL PASO | ||||||||
State: | TX | ||||||||
PostalCode: | 799124435 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9153263951 | ||||||||
FaxNumber: | 9155850021 | ||||||||
Practice Location | |||||||||
Address1: | 1335 GERONIMO DR | ||||||||
Address2: |   | ||||||||
City: | EL PASO | ||||||||
State: | TX | ||||||||
PostalCode: | 799251836 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9155912704 | ||||||||
FaxNumber: | 9152250413 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/11/2017 | ||||||||
LastUpdateDate: | 05/11/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | SARMIENTO | ||||||||
AuthorizedOfficialFirstName: | JORGE | ||||||||
AuthorizedOfficialMiddleName: | LUIS | ||||||||
AuthorizedOfficialTitleorPosition: | MEMBER/MANAGER | ||||||||
AuthorizedOfficialTelephone: | 9153263951 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | M.D. | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.