=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720109648
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PSYCHIATRIC HEALTH SERVICES, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2007
-----------------------------------------------------
Last Update Date | 08/02/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1717 BROWN ST SUITE 2B
-----------------------------------------------------
City | EL PASO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79902-4727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-533-7755
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1717 BROWN ST SUITE 2B
-----------------------------------------------------
City | EL PASO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79902-4727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-533-7755
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ANGEL MARCELO RODRIGUEZ-CHEVRES
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 915-533-7755
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | H3513
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------