Healthcare Provider Details

I. General information

NPI: 1992147565
Provider Name (Legal Business Name): SOUTHWEST PLASTIC SURGERY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2013
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1387 GEORGE DIETER DR BLDG C301
EL PASO TX
79936-7410
US

IV. Provider business mailing address

1387 GEORGE DIETER DR BLDG C301
EL PASO TX
79936-7410
US

V. Phone/Fax

Practice location:
  • Phone: 915-590-7900
  • Fax: 915-590-7902
Mailing address:
  • Phone: 915-590-7900
  • Fax: 915-590-7902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberN8437
License Number StateTX

VIII. Authorized Official

Name: FRANCISCO J AGULLO
Title or Position: PRESIDENT
Credential:
Phone: 915-590-7900