Healthcare Provider Details

I. General information

NPI: 1356117691
Provider Name (Legal Business Name): MULTI-SPECIALTY GROUP OF NEW MEXICO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 N ZARAGOZA RD STE B
EL PASO TX
79936-8903
US

IV. Provider business mailing address

1512 N ZARAGOZA RD STE B
EL PASO TX
79936-8903
US

V. Phone/Fax

Practice location:
  • Phone: 915-213-0900
  • Fax:
Mailing address:
  • Phone: 915-213-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: FAHAD OMAR
Title or Position: PROVIDER
Credential: MD
Phone: 915-213-0900