MEDICARE: PEDIATRIC GI OF EL PASO, PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	133V00000X	Registered Dietitian
2	235Z00000X	Speech-Language Pathologist
3	363LP0200X	Pediatric Nurse Practitioner
4	2080P0206X	Pediatric Gastroenterology Physician

General Provider Information

NPI Number	:	1689262313
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC GI OF EL PASO, PLLC

Provider Business Mailing Address
First Line	:	1351 N ZARAGOZA RD BLDG J-1
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-7902
Country	:	US
Telephone Number	:	915-615-7005
Fax Number	:

Provider Business Practice Location Address
First Line	:	1351 N ZARAGOZA RD STE 1
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-7902
Country	:	US
Telephone Number	:	915-615-7005
Fax Number	:	855-618-2437

Authorized Official
Title or Position	:	OWNER
Name	:	EDUARDO D ROSAS-BLUM
Credential	:	MD
Telephone Number	:	915-615-7005

Provider Enumeration Date	:	01/07/2021
Last Update Date	:	05/01/2026

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