Healthcare Provider Details

I. General information

NPI: 1346243235
Provider Name (Legal Business Name): RAFAEL ARMENDARIZ D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 04/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6974 GATEWAY BLVD E STE F
EL PASO TX
79915-1115
US

IV. Provider business mailing address

1335 GERONIMO DR
EL PASO TX
79925-1836
US

V. Phone/Fax

Practice location:
  • Phone: 915-774-8850
  • Fax: 915-598-3946
Mailing address:
  • Phone: 915-591-2704
  • Fax: 915-225-0413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberJ9953
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: