Healthcare Provider Details

I. General information

NPI: 1770613572
Provider Name (Legal Business Name): CITY OF EL PASO TEXAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/21/2022
Certification Date: 07/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5115 EL PASO DRIVE
EL PASO TX
79905-2818
US

IV. Provider business mailing address

5115 EL PASO DR STE A
EL PASO TX
79905-2818
US

V. Phone/Fax

Practice location:
  • Phone: 915-771-5779
  • Fax: 915-771-5893
Mailing address:
  • Phone: 915-212-6512
  • Fax: 915-212-0168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number45DO895373
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MARY ANN GALLEGOS
Title or Position: ADMINISTRATIVE SERVICES MANAGER
Credential:
Phone: 915-212-6508