Healthcare Provider Details

I. General information

NPI: 1639810740
Provider Name (Legal Business Name): PROJECT VIDA HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14964 GREG DR
EL PASO TX
79938-9213
US

IV. Provider business mailing address

3607 RIVERA AVE
EL PASO TX
79905-2415
US

V. Phone/Fax

Practice location:
  • Phone: 915-465-1191
  • Fax:
Mailing address:
  • Phone: 915-465-1191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM DAVID SCHLESINGER
Title or Position: CEO
Credential:
Phone: 915-533-7057