Healthcare Provider Details
I. General information
NPI: 1649018359
Provider Name (Legal Business Name): RIVER VALLEY PULMONARY CONSULTANTS, PA
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 07/17/2024
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
7878 GATEWAY BLVD EAST SUITE 204
EL PASO TX
79915
US
IV. Provider business mailing address
7878 GATEWAY BLVD EAST SUITE 204
EL PASO TX
79915
US
V. Phone/Fax
- Phone: 915-999-4009
- Fax:
- Phone: 915-999-4009
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207RC0200X |
| Taxonomy | Critical Care Medicine (Internal Medicine) Physician |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207RP1001X |
| Taxonomy | Pulmonary Disease Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
ADOLFO
N
ANCHONDO
Title or Position: DIRECTOR
Credential: MD
Phone: 915-532-2477