Healthcare Provider Details

I. General information

NPI: 1386919017
Provider Name (Legal Business Name): EASTSIDE TOTAL HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2012
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11680 PEBBLE HILLS BLVD STE 107-109
EL PASO TX
79936-1090
US

IV. Provider business mailing address

11680 PEBBLE HILLS BLVD STE 107-109
EL PASO TX
79936-1090
US

V. Phone/Fax

Practice location:
  • Phone: 915-313-7322
  • Fax: 915-313-7324
Mailing address:
  • Phone: 915-313-7322
  • Fax: 915-313-7324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberN5104
License Number StateTX

VIII. Authorized Official

Name: DR. ARTURO HERNANDEZ
Title or Position: PARTNER
Credential: M.D.
Phone: 915-313-7322