| Lulac Project Amistad | |
|
3210 Dyer St El Paso TX 79930-6230 | |
| (915) 298-7304 | |
| Not Available |
| Full Name | Lulac Project Amistad |
|---|---|
| Speciality | Social Worker |
| Location | 3210 Dyer St, El Paso, Texas |
| Authorized Official Name and Position | Kenneth R Ward (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 9155323790 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lulac Project Amistad 3210 Dyer St El Paso TX 79930-6230 Ph: () - | Lulac Project Amistad 3210 Dyer St El Paso TX 79930-6230 Ph: (915) 298-7304 |
| NPI Number | 1629582028 |
|---|---|
| Provider Enumeration Date | 11/21/2017 |
| Last Update Date | 02/01/2021 |
| Certification Date | 01/28/2021 |
| Medicare PECOS PAC ID | 9739588864 |
|---|---|
| Medicare Enrollment ID | O20210524000075 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629582028 | NPI | - | NPPES |
| Provider Name | Marisela Padilla |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275135444 PECOS PAC ID: 8820498959 Enrollment ID: I20210611000552 |
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