Healthcare Provider Details

I. General information

NPI: 1023558673
Provider Name (Legal Business Name): EL PASO ORTHOPAEDIC SURGERY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2017
Last Update Date: 03/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9999 KENWORTHY ST SUITE C
EL PASO TX
79924-4412
US

IV. Provider business mailing address

PO BOX 910329
DALLAS TX
75391-0329
US

V. Phone/Fax

Practice location:
  • Phone: 915-533-7465
  • Fax: 915-534-1246
Mailing address:
  • Phone: 915-533-7465
  • Fax: 915-534-5289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. RAQUEL SILVA
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 915-533-7465