Healthcare Provider Details

I. General information

NPI: 1851309371
Provider Name (Legal Business Name): CARTY-ANNA PATRICE P.A.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARTY-ANNA PATRICE-MOMOH P.A.C.

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12201 MONTWOOD DR
EL PASO TX
79938-2620
US

IV. Provider business mailing address

12201 MONTWOOD DR BLDG A
EL PASO TX
79938-2620
US

V. Phone/Fax

Practice location:
  • Phone: 915-320-7809
  • Fax: 915-598-3946
Mailing address:
  • Phone: 915-320-7809
  • Fax: 915-598-3946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA04923
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: