Healthcare Provider Details

I. General information

NPI: 1669551297
Provider Name (Legal Business Name): JOSE MANUEL RENTERIA-ALVAREZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 N MESA ST STE G
EL PASO TX
79902-3575
US

IV. Provider business mailing address

2311 N MESA ST STE G
EL PASO TX
79902-3575
US

V. Phone/Fax

Practice location:
  • Phone: 915-542-1751
  • Fax: 915-545-1660
Mailing address:
  • Phone: 915-542-1751
  • Fax: 915-545-1660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberN4695
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: