Healthcare Provider Details

I. General information

NPI: 1548446867
Provider Name (Legal Business Name): WEST TEXAS COSMETIC SURGICAL ASSOC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 N OREGON ST SUITE 755
EL PASO TX
79902-3590
US

IV. Provider business mailing address

1700 N OREGON ST SUITE 755
EL PASO TX
79902-3590
US

V. Phone/Fax

Practice location:
  • Phone: 915-541-1225
  • Fax: 915-541-1229
Mailing address:
  • Phone: 915-541-1225
  • Fax: 915-541-1229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberE4959
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberL1894
License Number StateTX

VIII. Authorized Official

Name: ELSA JERNIGAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 915-541-1225