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NPI Code Detail

MEDICARE: AMANECER PSYCHOLOGICAL SERVICES, P.C.

MEDICARE: AMANECER PSYCHOLOGICAL SERVICES, P.C.
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
1276400000XSubstance Use Disorder Rehabilitation Hospital Unit3550-3555TX
2261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center3550-3555TX

General Provider Information

NPI Number : 1346402070
Entity Type Code : Organization
Provider Name (Legal Business Name) : AMANECER PSYCHOLOGICAL SERVICES, P.C.
Provider Business Mailing Address
First Line : 1219 BARRANCA DR
Second Line : STE A AND B
City : EL PASO
State : TX
Zip : 79935-4601
Country : US
Telephone Number : 915-779-5600
Fax Number : 915-779-5605
Provider Business Practice Location Address
First Line : 1219 BARRANCA DR
Second Line : STE A AND B
City : EL PASO
State : TX
Zip : 79935-4601
Country : US
Telephone Number : 915-779-5600
Fax Number : 915-779-5605
Authorized Official
Title or Position : PRESIDENT
Name : RODOLFO BASURTO
Credential : PHD
Telephone Number : 915-779-5600
Provider Enumeration Date : 06/25/2008
Last Update Date : 09/19/2012

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