Healthcare Provider Details

I. General information

NPI: 1386117513
Provider Name (Legal Business Name): LEO ALTENBERG MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 05/20/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 W HAGUE RD STE 110
EL PASO TX
79902-5804
US

IV. Provider business mailing address

125 W HAGUE RD STE 110
EL PASO TX
79902-5804
US

V. Phone/Fax

Practice location:
  • Phone: 915-271-8400
  • Fax: 915-300-0115
Mailing address:
  • Phone: 915-271-8400
  • Fax: 915-300-0115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LEO LAWRENCE ALTENBERG
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 915-271-8400