Basic Information
| Provider Information | |||||||||
| NPI: | 1780929489 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RIO GRANDE PSYCHIATRIC ASSOCIATES PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4849 N MESA ST | ||||||||
| Address2: | STE 201 | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799125916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9153516600 | ||||||||
| FaxNumber: | 9153516601 | ||||||||
| Practice Location | |||||||||
| Address1: | 7601 FANNIN ST | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137962273 | ||||||||
| FaxNumber: | 7137955375 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2012 | ||||||||
| LastUpdateDate: | 08/09/2018 | ||||||||
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| AuthorizedOfficialLastName: | CHOUBKHA | ||||||||
| AuthorizedOfficialFirstName: | NORA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER MD | ||||||||
| AuthorizedOfficialTelephone: | 9154229383 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | P4301 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 330138401 | 05 | TX | MEDICAID |