Healthcare Provider Details

I. General information

NPI: 1740454297
Provider Name (Legal Business Name): DENISE N. YOCUM P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 12/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E CLIFF DR SUITE 2A
EL PASO TX
79902-4850
US

IV. Provider business mailing address

1250 E CLIFF DR SUITE 2A
EL PASO TX
79902-4850
US

V. Phone/Fax

Practice location:
  • Phone: 915-577-7951
  • Fax: 915-577-7952
Mailing address:
  • Phone: 915-577-7951
  • Fax: 915-577-7952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberTEMPORARY
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberTEMPORARY
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: