Healthcare Provider Details

I. General information

NPI: 1346409984
Provider Name (Legal Business Name): MT WEST FAMILY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6151 DEW DR STE 410
EL PASO TX
79912-3912
US

IV. Provider business mailing address

PO BOX 13203
EL PASO TX
79913-3203
US

V. Phone/Fax

Practice location:
  • Phone: 915-584-7920
  • Fax: 915-584-8546
Mailing address:
  • Phone: 915-584-7920
  • Fax: 915-584-8546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberG8481
License Number StateTX

VIII. Authorized Official

Name: MRS. CARLA PATRICIA GARCIA
Title or Position: CERTIFIED MEDICAL CODER
Credential: PAS
Phone: 915-584-7920