| North East Family Clinic Pa | |
|
9740 Dyer St Ste 111&112 El Paso TX 79924-4752 | |
| (915) 500-5030 | |
| Not Available |
| Full Name | North East Family Clinic Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 9740 Dyer St Ste 111&112, El Paso, Texas |
| Authorized Official Name and Position | Claudia Jacquez (MD LIASION) |
| Authorized Official Contact | 9152024463 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| North East Family Clinic Pa 1500 Finsterwald Pl El Paso TX 79936-6011 Ph: (915) 222-8747 | North East Family Clinic Pa 9740 Dyer St Ste 111&112 El Paso TX 79924-4752 Ph: (915) 500-5030 |
| NPI Number | 1255849097 |
|---|---|
| Provider Enumeration Date | 01/15/2018 |
| Last Update Date | 03/07/2023 |
| Medicare PECOS PAC ID | 8820343064 |
|---|---|
| Medicare Enrollment ID | O20180612002160 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255849097 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Miguel Angel Caro |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598936718 PECOS PAC ID: 1355390055 Enrollment ID: I20050120000340 |
| Provider Name | Mauro Provencio |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952560682 PECOS PAC ID: 0840456141 Enrollment ID: I20120731000318 |
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