MEDICARE: C CARE CARDIOVASCULAR CENTER

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	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1790333516
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C CARE CARDIOVASCULAR CENTER

Provider Business Mailing Address
First Line	:	1605 GEORGE DIETER DR STE 636
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-5600
Country	:	US
Telephone Number	:	915-671-1371
Fax Number	:	915-219-9022

Provider Business Practice Location Address
First Line	:	1351 N ZARAGOZA RD BLDG L
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-7902
Country	:	US
Telephone Number	:	915-500-4420
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ENOCH AGUNANNE
Credential	:	MD
Telephone Number	:	915-500-4420

Provider Enumeration Date	:	08/27/2019
Last Update Date	:	03/13/2024

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