Healthcare Provider Details

I. General information

NPI: 1841119781
Provider Name (Legal Business Name): JONATHAN MARRUFO ATC, LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14964 GREG DR
EL PASO TX
79938-9213
US

IV. Provider business mailing address

12130 PEBBLE HILLS BLVD APT H203
EL PASO TX
79936-1031
US

V. Phone/Fax

Practice location:
  • Phone: 915-926-5026
  • Fax:
Mailing address:
  • Phone: 915-701-8019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number9421
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: