Healthcare Provider Details

I. General information

NPI: 1598775348
Provider Name (Legal Business Name): EL PASO INTEGRATED PHYSICIANS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 08/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4532 N MESA ST 2ND FLOOR
EL PASO TX
79912
US

IV. Provider business mailing address

PO BOX 3157
EL PASO TX
79923-3157
US

V. Phone/Fax

Practice location:
  • Phone: 915-544-0326
  • Fax: 915-544-2897
Mailing address:
  • Phone: 915-544-0326
  • Fax: 915-544-2897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT A MORENO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 915-544-0326