Healthcare Provider Details

I. General information

NPI: 1003819855
Provider Name (Legal Business Name): JAMES ENRIQUE RODRIGUEZ VARGAS P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 12/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6974 GATEWAY BLVD E STE F
EL PASO TX
79915-1115
US

IV. Provider business mailing address

3607 RIVERA AVE
EL PASO TX
79905-2415
US

V. Phone/Fax

Practice location:
  • Phone: 915-591-2704
  • Fax: 915-598-3946
Mailing address:
  • Phone: 915-533-7057
  • Fax: 915-757-1640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA03671
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: