Healthcare Provider Details

I. General information

NPI: 1932849254
Provider Name (Legal Business Name): MIRIAM OLMOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6450 N DESERT BLVD STE B106
EL PASO TX
79912-8524
US

IV. Provider business mailing address

6450 N DESERT BLVD STE B106
EL PASO TX
79912-8524
US

V. Phone/Fax

Practice location:
  • Phone: 915-308-0123
  • Fax:
Mailing address:
  • Phone: 915-308-0123
  • Fax: 915-234-2970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: