Healthcare Provider Details

I. General information

NPI: 1861190753
Provider Name (Legal Business Name): VILLA PAIN INSTITUTE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6955 N MESA ST STE 200
EL PASO TX
79912-4442
US

IV. Provider business mailing address

6955 N MESA ST STE 200
EL PASO TX
79912-4442
US

V. Phone/Fax

Practice location:
  • Phone: 915-532-3600
  • Fax: 877-296-5238
Mailing address:
  • Phone: 833-339-7246
  • Fax: 915-257-6302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROSEMARY DE LA CRUZ
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 833-339-7246