MEDICARE: MS. GRACIELA IRENE PINON L.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
1	101YP2500X	Professional Counselor	02726	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7047LC	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1902815582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GRACIELA IRENE PINON L.P.C.

Provider Business Mailing Address
First Line	:	905 NOBLE ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902-4739
Country	:	US
Telephone Number	:	915-543-4933
Fax Number	:	915-544-7080

Provider Business Practice Location Address
First Line	:	905 NOBLE ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902-4739
Country	:	US
Telephone Number	:	915-543-4933
Fax Number	:	915-544-7080

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	01/22/2008

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