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General NPI Number Information
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NPI Number | 1780912055
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Entity Type | Organization
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Legal Business Name | ULISSES ACUNA
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Dates
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Enumeration Date | 11/25/2009
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Last Update Date | 11/25/2009
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Provider Practice Location Address
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Address Line | 1393 GEORGE DIETER DR STE D
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City | EL PASO
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State | TX
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Zip | 79936-7410
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Country | US
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Telephone | 915-590-7008
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Fax | 915-590-7009
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Provider Business Mailing Address
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Address Line | 1393 GEORGE DIETER DR STE D
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City | EL PASO
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State | TX
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Zip | 79936-7410
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Country | US
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Telephone | 915-590-7008
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Fax | 915-590-7009
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Authorized Official
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Title or Position | OWNER
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Name | MR. ULISSES ACUNA
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Credential |
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Telephone | 915-590-7008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 0064030
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License Number State | TX
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