Basic Information
| Provider Information | |||||||||
| NPI: | 1467567750 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EL PASO ORTHOPEADIC SURGERY GROUP AND CENTER FOR SPORTS MEDICINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1720 MURCHISON DR | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799022921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155337465 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9999 KENWORTHY ST STE C | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799244413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9157597757 | ||||||||
| FaxNumber: | 9157517554 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | REYES | ||||||||
| AuthorizedOfficialFirstName: | ARIEL | ||||||||
| AuthorizedOfficialMiddleName: | AGUILAR | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 9155337465 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | L.P.T | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | 1079374 | TX | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.