Healthcare Provider Details

I. General information

NPI: 1710110069
Provider Name (Legal Business Name): YSLETA GENERAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2009
Last Update Date: 09/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 N ZARAGOZA RD
EL PASO TX
79907-5565
US

IV. Provider business mailing address

128 N ZARAGOZA RD
EL PASO TX
79907-5565
US

V. Phone/Fax

Practice location:
  • Phone: 915-859-7901
  • Fax: 915-859-7902
Mailing address:
  • Phone: 915-859-7901
  • Fax: 915-859-7902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD0993
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0993
License Number StateTX

VIII. Authorized Official

Name: DR. PEDRO A ORTEGA
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 915-859-7901