Healthcare Provider Details

I. General information

NPI: 1538720552
Provider Name (Legal Business Name): RAFAEL IVAN PARRA TORRES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2019
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 N MAIN ST
LAS CRUCES NM
88001-1128
US

IV. Provider business mailing address

5959 GATEWAY BLVD W STE 120
EL PASO TX
79925-3315
US

V. Phone/Fax

Practice location:
  • Phone: 915-263-3715
  • Fax:
Mailing address:
  • Phone: 915-779-1716
  • Fax: 915-779-1754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name: RAFAEL IVAN PARRA TORRES
Title or Position: OWNER
Credential: SA-C
Phone: 915-263-3715