| Provencio Enterprises Incorporated | |
|
5380 N Mesa St Ste 108 El Paso TX 79912-5869 | |
| (915) 613-3989 | |
| (915) 503-2737 |
| Full Name | Provencio Enterprises Incorporated |
|---|---|
| Speciality | Clinic/center |
| Location | 5380 N Mesa St Ste 108, El Paso, Texas |
| Authorized Official Name and Position | Griselda P Oaxaca (OWNER/DIRECTOR) |
| Authorized Official Contact | 9156133989 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Provencio Enterprises Incorporated 5380 N Mesa St Ste 108 El Paso TX 79912-5869 Ph: (915) 613-3989 | Provencio Enterprises Incorporated 5380 N Mesa St Ste 108 El Paso TX 79912-5869 Ph: (915) 613-3989 |
| NPI Number | 1790260107 |
|---|---|
| Provider Enumeration Date | 10/02/2018 |
| Last Update Date | 10/02/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790260107 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Secondary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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