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General NPI Number Information
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NPI Number | 1366264483
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Entity Type | Organization
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Legal Business Name | BIG TREE MEDICAL OF EL PASO
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Dates
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Enumeration Date | 10/29/2024
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 5500 DONIPHAN DR STE 201-202
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City | EL PASO
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State | TX
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Zip | 79932-1454
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Country | US
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Telephone | 915-455-1119
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Fax | 877-209-8941
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Provider Business Mailing Address
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Address Line | 5500 DONIPHAN DR STE 201-202
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City | EL PASO
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State | TX
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Zip | 79932-1454
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Country | US
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Telephone | 915-455-1119
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Fax | 877-209-8941
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Authorized Official
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Title or Position | OWNER
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Name | TANYA MARIN
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Credential | DNP, APRN, CPNP-PC/A
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Telephone | 915-740-4344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080B0002X
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Taxonomy Name | Pediatric Obesity Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2083B0002X
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Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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