MEDICARE: CENTER FOR INTEGRATIVE CANCER MEDICINE, P.A.

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	174400000X	Specialist	H2409	TX

General Provider Information

NPI Number	:	1164480885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR INTEGRATIVE CANCER MEDICINE, P.A.

Provider Business Mailing Address
First Line	:	1733 CURIE DRIVE
Second Line	:	SUITE 305
City	:	EL PASO
State	:	TX
Zip	:	79902-2910
Country	:	US
Telephone Number	:	915-351-1989
Fax Number	:	915-351-1858

Provider Business Practice Location Address
First Line	:	1733 CURIE DRIVE
Second Line	:	SUITE 305
City	:	EL PASO
State	:	TX
Zip	:	79902-2910
Country	:	US
Telephone Number	:	915-351-1989
Fax Number	:	915-351-1858

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JESUS ALBERTO GOMEZ
Credential	:	M.D.
Telephone Number	:	915-351-1989

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	09/18/2008

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