Healthcare Provider Details

I. General information

NPI: 1467097683
Provider Name (Legal Business Name): EL PASO SLEEP DISORDER CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2019
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 JOE BATTLE BLVD
EL PASO TX
79938-2667
US

IV. Provider business mailing address

1016 QUINTA ANTIGUA LN
EL PASO TX
79912-2039
US

V. Phone/Fax

Practice location:
  • Phone: 915-779-7378
  • Fax: 915-779-2822
Mailing address:
  • Phone: 915-779-3778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: GONZALO DIAZ
Title or Position: OWNER
Credential: MD
Phone: 915-471-8218