MEDICARE: VILLA PAIN INSTITUTE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician
2	208VP0014X	Interventional Pain Medicine Physician

General Provider Information

NPI Number	:	1134957103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLA PAIN INSTITUTE PLLC

Provider Business Mailing Address
First Line	:	6955 N MESA ST STE 200
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-4442
Country	:	US
Telephone Number	:	833-339-7246
Fax Number	:	915-257-6302

Provider Business Practice Location Address
First Line	:	7812 GATEWAY BLVD E STE 230
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79915-1837
Country	:	US
Telephone Number	:	833-339-7246
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN OWNER
Name	:	ROSEMARY DE LA CRUZ
Credential	:	MD
Telephone Number	:	978-701-1754

Provider Enumeration Date	:	07/22/2024
Last Update Date	:	07/22/2024

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Directions to “VILLA PAIN INSTITUTE PLLC ” Practice Location

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