Healthcare Provider Details

I. General information

NPI: 1235464249
Provider Name (Legal Business Name): ADRIAN O UGARTE MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2009
Last Update Date: 10/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9963A ALAMEDA AVE
SOCORRO TX
79927-2963
US

IV. Provider business mailing address

5959 GATEWAY BLVD W SUITE 120
EL PASO TX
79925-3331
US

V. Phone/Fax

Practice location:
  • Phone: 915-872-0477
  • Fax:
Mailing address:
  • Phone: 915-779-1716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberJ6784
License Number StateTX

VIII. Authorized Official

Name: DR. ADRIAN O UGARTE
Title or Position: DIRECTOR
Credential: MD
Phone: 915-872-0477