Healthcare Provider Details

I. General information

NPI: 1902549223
Provider Name (Legal Business Name): LOS CERROS MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 N VIRGINIA ST STE 211B
EL PASO TX
79902-5307
US

IV. Provider business mailing address

812 N VIRGINIA ST STE 211B
EL PASO TX
79902-5307
US

V. Phone/Fax

Practice location:
  • Phone: 915-342-2839
  • Fax:
Mailing address:
  • Phone: 915-342-2839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RICARDO SWATTS
Title or Position: ADMINISTRATOR
Credential: NP
Phone: 915-487-9923