Healthcare Provider Details

I. General information

NPI: 1851883003
Provider Name (Legal Business Name): CORAZONES JOVENES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 06/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13912 DADE RD
EL PASO TX
79938-8277
US

IV. Provider business mailing address

13912 DADE RD
EL PASO TX
79938-8277
US

V. Phone/Fax

Practice location:
  • Phone: 915-921-8802
  • Fax:
Mailing address:
  • Phone: 915-921-8802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: LILIA QUINTANA
Title or Position: MANAGER
Credential:
Phone: 915-408-1042