Healthcare Provider Details

I. General information

NPI: 1013773084
Provider Name (Legal Business Name): PEDIATRIC PULMONARY HEALTH & ASTHMA CARE OF EL PASO, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2270 JOE BATTLE BLVD STE E-G
EL PASO TX
79938-2609
US

IV. Provider business mailing address

2270 JOE BATTLE BLVD STE E-G
EL PASO TX
79938-2609
US

V. Phone/Fax

Practice location:
  • Phone: 915-642-9444
  • Fax:
Mailing address:
  • Phone: 915-642-9444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number
License Number State

VIII. Authorized Official

Name: LILIANA VARELA
Title or Position: ADMINISTRATOR
Credential:
Phone: 915-820-9398