Healthcare Provider Details

I. General information

NPI: 1285063990
Provider Name (Legal Business Name): PARA PEDIATRIC & ADULT REHABILITATION ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2013
Last Update Date: 03/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 N MESA ST STE A2-343
EL PASO TX
79902-1538
US

IV. Provider business mailing address

PO BOX 23098
EL PASO TX
79923-0098
US

V. Phone/Fax

Practice location:
  • Phone: 806-535-9695
  • Fax:
Mailing address:
  • Phone: 806-535-9695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License NumberN9562
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberN9562
License Number StateTX

VIII. Authorized Official

Name: CALLENDA HACKER
Title or Position: OWNER
Credential: M.D.
Phone: 806-535-9695