=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447704713
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALAMILLO FAMILY PRACTICE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2016
-----------------------------------------------------
Last Update Date | 08/20/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1975 N VETERANS BLVD SUITE 6
-----------------------------------------------------
City | EAGLE PASS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78852-6114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-758-1633
-----------------------------------------------------
Fax | 830-773-6989
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 740 OLD PIONEER RD
-----------------------------------------------------
City | EAGLE PASS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78852-5915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-313-6381
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN ASSISTANT-CERTIFIED
-----------------------------------------------------
Name | MRS. ELIZABETH MARIE MARTINEZ-ALAMILLO
-----------------------------------------------------
Credential | PA-C
-----------------------------------------------------
Telephone | 210-313-6381
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------