Healthcare Provider Details

I. General information

NPI: 1629393871
Provider Name (Legal Business Name): JOSE ARTURO MENJIVAR CRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 03/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 N PIEDRAS ST
EL PASO TX
79930-4210
US

IV. Provider business mailing address

5001 N PIEDRAS ST
EL PASO TX
79930-4210
US

V. Phone/Fax

Practice location:
  • Phone: 915-564-6100
  • Fax: 915-564-7839
Mailing address:
  • Phone: 915-564-6100
  • Fax: 915-564-7839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2278E1000X
TaxonomyEducational Certified Respiratory Therapist
License Number64966
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2278P1004X
TaxonomyPulmonary Diagnostics Certified Respiratory Therapist
License Number64966
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: