MEDICARE: OCCMED CENTERS OF 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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	J6684	TX

General Provider Information

NPI Number	:	1265922876
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCCMED CENTERS OF EL PASO, PA

Provider Business Mailing Address
First Line	:	311 CAMINO ESTANCIAS
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-3424
Country	:	US
Telephone Number	:	915-593-9300
Fax Number	:	915-593-9310

Provider Business Practice Location Address
First Line	:	311 CAMINO ESTANCIAS
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-3424
Country	:	US
Telephone Number	:	915-593-9300
Fax Number	:	915-593-9310

Authorized Official
Title or Position	:	OWNER
Name	:	MANOUCHEHR REFAEIAN
Credential	:	M.D
Telephone Number	:	915-593-9300

Provider Enumeration Date	:	05/18/2018
Last Update Date	:	05/18/2018

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