Healthcare Provider Details

I. General information

NPI: 1649059700
Provider Name (Legal Business Name): PALLIATIVE COALITION PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2023
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 WYOMING AVE
EL PASO TX
79903-3508
US

IV. Provider business mailing address

4849 N MESA ST STE 201
EL PASO TX
79912-5919
US

V. Phone/Fax

Practice location:
  • Phone: 915-307-4669
  • Fax:
Mailing address:
  • Phone: 915-351-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSE BURGOS
Title or Position: OWNER
Credential:
Phone: 915-307-4669