MEDICARE: DEL NORTE IMAGING LLC

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	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center
2	261QR0208X	Mobile Radiology Clinic/Center
3	261QR0200X	Radiology Clinic/Center	M3476	TX

General Provider Information

NPI Number	:	1447578778
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEL NORTE IMAGING LLC

Provider Business Mailing Address
First Line	:	3130 N LEE TREVINO DR
Second Line	:	SUITE 114
City	:	EL PASO
State	:	TX
Zip	:	79936-2060
Country	:	US
Telephone Number	:	915-595-8815
Fax Number	:	915-595-1058

Provider Business Practice Location Address
First Line	:	3130 N LEE TREVINO DR
Second Line	:	SUITE 114
City	:	EL PASO
State	:	TX
Zip	:	79936-2060
Country	:	US
Telephone Number	:	915-595-8815
Fax Number	:	915-595-1058

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MANUEL BORREGO
Credential	:	M.D.
Telephone Number	:	915-595-8815

Provider Enumeration Date	:	05/11/2010
Last Update Date	:	05/11/2010

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Directions to “DEL NORTE IMAGING LLC ” Practice Location

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