=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851309371
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARTY-ANNA PATRICE P.A.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2006
-----------------------------------------------------
Last Update Date | 10/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12201 MONTWOOD DR
-----------------------------------------------------
City | EL PASO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79938-2620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-320-7809
-----------------------------------------------------
Fax | 915-598-3946
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12201 MONTWOOD DR BLDG A
-----------------------------------------------------
City | EL PASO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79938-2620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-320-7809
-----------------------------------------------------
Fax | 915-598-3946
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA04923
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------