| El Paso Center For Pediatric Gastroenterology Pa | |
|
2311 N Mesa St Ste C El Paso TX 79902-3575 | |
| (915) 269-0064 | |
| Not Available |
| Full Name | El Paso Center For Pediatric Gastroenterology Pa |
|---|---|
| Speciality | Pediatrics - Pediatric Gastroenterology |
| Location | 2311 N Mesa St Ste C, El Paso, Texas |
| Authorized Official Name and Position | Maridine Co (PRESIDENT) |
| Authorized Official Contact | 9152690064 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| El Paso Center For Pediatric Gastroenterology Pa 2311 N Mesa St Ste C El Paso TX 79902-3575 Ph: (915) 269-0064 | El Paso Center For Pediatric Gastroenterology Pa 2311 N Mesa St Ste C El Paso TX 79902-3575 Ph: (915) 269-0064 |
| NPI Number | 1194208892 |
|---|---|
| Provider Enumeration Date | 09/10/2018 |
| Last Update Date | 09/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194208892 | NPI | - | NPPES |
| 384898803 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Secondary |
| 2080P0206X | Pediatrics - Pediatric Gastroenterology | (* (Not Available)) | Primary |
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