Healthcare Provider Details

I. General information

NPI: 1063720399
Provider Name (Legal Business Name): JUST-MARSE, L.P., DBA DE VINO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2010
Last Update Date: 09/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11150 MONTWOOD DR BLDG B
EL PASO TX
79936-4259
US

IV. Provider business mailing address

11150 MONTWOOD DR BLDG B
EL PASO TX
79936-4259
US

V. Phone/Fax

Practice location:
  • Phone: 915-594-7999
  • Fax: 915-594-7924
Mailing address:
  • Phone: 915-594-7999
  • Fax: 915-594-7924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. ROSA I TORRES
Title or Position: CEO
Credential:
Phone: 915-594-7994