Healthcare Provider Details

I. General information

NPI: 1902062789
Provider Name (Legal Business Name): CIRCULATION TESTING FACILITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10470 VISTA DEL SOL DR STE 109
EL PASO TX
79925-7948
US

IV. Provider business mailing address

530 SIERRA ST
EL PASO TX
79903-5216
US

V. Phone/Fax

Practice location:
  • Phone: 915-629-0522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XC2903X
TaxonomyVascular Specialist/Technologist Cardiovascular
License Number
License Number State

VIII. Authorized Official

Name: MR. JORGE RODRIGUEZ
Title or Position: OWNER
Credential: RVT, RVS
Phone: 915-820-4190