| Premier Primary Care Clinic Llc | |
|
10921 Pellicano Dr Ste 121 El Paso TX 79935-4604 | |
| (915) 320-7707 | |
| (915) 892-1531 |
| Full Name | Premier Primary Care Clinic Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 10921 Pellicano Dr Ste 121, El Paso, Texas |
| Authorized Official Name and Position | Karina Mendoza-marcial (OWNER/NP) |
| Authorized Official Contact | 9155921531 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premier Primary Care Clinic Llc 10921 Pellicano Dr Ste 121 El Paso TX 79935-4604 Ph: (915) 320-7707 | Premier Primary Care Clinic Llc 10921 Pellicano Dr Ste 121 El Paso TX 79935-4604 Ph: (915) 320-7707 |
| NPI Number | 1063034221 |
|---|---|
| Provider Enumeration Date | 05/11/2020 |
| Last Update Date | 04/08/2021 |
| Medicare PECOS PAC ID | 4385075993 |
|---|---|
| Medicare Enrollment ID | O20210414000067 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063034221 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Primary |
| Provider Name | Karina Mendoza-marcial |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902456452 PECOS PAC ID: 0345572293 Enrollment ID: I20191028000514 |
| Provider Name | Maribel Magallanes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912574781 PECOS PAC ID: 1951704808 Enrollment ID: I20210729001720 |
| Provider Name | Jose Alberto Ruiz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629669023 PECOS PAC ID: 6305243536 Enrollment ID: I20210930001037 |
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