MEDICARE: PEDIATRIC PARTNERS EL PASO, PA

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	208000000X	Pediatrics Physician	K6249	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144630682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC PARTNERS EL PASO, PA

Provider Business Mailing Address
First Line	:	1390 GEORGE DIETER
Second Line	:	SUITE 100
City	:	EL PASO
State	:	TX
Zip	:	79936-7423
Country	:	US
Telephone Number	:	915-591-7704
Fax Number	:	915-591-7734

Provider Business Practice Location Address
First Line	:	1390 GEORGE DIETER
Second Line	:	SUITE 100
City	:	EL PASO
State	:	TX
Zip	:	79936-7423
Country	:	US
Telephone Number	:	915-591-7704
Fax Number	:	915-591-7734

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSE PRIETO JR.
Credential	:	M.D.
Telephone Number	:	915-591-7704

Provider Enumeration Date	:	05/06/2014
Last Update Date	:	05/29/2015

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Directions to “PEDIATRIC PARTNERS EL PASO, PA ” Practice Location

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