MEDICARE: EAST DESERT OB-GYN ASSOCIATES PA

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	207V00000X	Obstetrics & Gynecology Physician	L5299	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730186461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST DESERT OB-GYN ASSOCIATES PA

Provider Business Mailing Address
First Line	:	10657 VISTA DEL SOL DR
Second Line	:	SUITE F
City	:	EL PASO
State	:	TX
Zip	:	79935-4528
Country	:	US
Telephone Number	:	915-594-9600
Fax Number	:	915-594-9601

Provider Business Practice Location Address
First Line	:	10657 VISTA DEL SOL DR
Second Line	:	SUITE F
City	:	EL PASO
State	:	TX
Zip	:	79935-4528
Country	:	US
Telephone Number	:	915-594-9600
Fax Number	:	915-594-9601

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANTONIO DELA ROSA IV
Credential	:	M.D.
Telephone Number	:	915-594-9600

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	01/08/2014

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