MEDICARE: DR. CHANEL MARIE ASSI D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	L1520	TX

General Provider Information

NPI Number	:	1255564431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHANEL MARIE ASSI D.O.

Provider Business Mailing Address
First Line	:	1001 BROADMOOR DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-2003
Country	:	US
Telephone Number	:	915-231-9252
Fax Number	:	915-231-9253

Provider Business Practice Location Address
First Line	:	1001 BROADMOOR DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-2003
Country	:	US
Telephone Number	:	915-231-9252
Fax Number	:	915-231-9253

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2009
Last Update Date	:	09/03/2009

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