Healthcare Provider Details

I. General information

NPI: 1689262313
Provider Name (Legal Business Name): PEDIATRIC GI OF EL PASO, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10470 VISTA DEL SOL DR STE 100
EL PASO TX
79925-7928
US

IV. Provider business mailing address

10470 VISTA DEL SOL DR STE 100
EL PASO TX
79925-7928
US

V. Phone/Fax

Practice location:
  • Phone: 915-615-7005
  • Fax:
Mailing address:
  • Phone: 915-615-7005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: EDUARDO D ROSAS-BLUM
Title or Position: OWNER
Credential: MD
Phone: 915-615-7005