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General NPI Number Information
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NPI Number | 1356435903
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Entity Type | Organization
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Legal Business Name | AMANECER PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6044 GATEWAY EAST SUITE 405
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City | EL PASO
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State | TX
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Zip | 79905
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Country | US
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Telephone | 915-779-5600
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Fax | 915-779-5605
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Provider Business Mailing Address
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Address Line | 6044 GATEWAY EAST SUITE 405
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City | EL PASO
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State | TX
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Zip | 79905
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Country | US
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Telephone | 915-779-5600
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Fax | 915-779-5605
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RODOLFO BASURTO
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Credential | PHD
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Telephone | 915-779-5600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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