MEDICARE: EASTSIDE FAMILY CARE CENTER PLLC

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	207R00000X	Internal Medicine Physician
2	207Q00000X	Family Medicine Physician
3	363LF0000X	Family Nurse Practitioner	612956	TX

General Provider Information

NPI Number	:	1770973414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTSIDE FAMILY CARE CENTER PLLC

Provider Business Mailing Address
First Line	:	1671 N ZARAGOZA RD STE B
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-8058
Country	:	US
Telephone Number	:	915-996-5210
Fax Number	:	915-213-5296

Provider Business Practice Location Address
First Line	:	1671 N ZARAGOZA RD STE B
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-8058
Country	:	US
Telephone Number	:	915-996-5210
Fax Number	:	915-213-5296

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JOE F TITTLE
Credential	:	FNP
Telephone Number	:	915-996-5210

Provider Enumeration Date	:	02/03/2015
Last Update Date	:	02/17/2026

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