MEDICARE: CENTRO SAN VICENTE

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	261QF0400X	Federally Qualified Health Center (FQHC)

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

General Provider Information

NPI Number	:	1841480902
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRO SAN VICENTE

Provider Business Mailing Address
First Line	:	1208 MYRTLE AVE
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79901-1602
Country	:	US
Telephone Number	:	915-351-8972
Fax Number	:

Provider Business Practice Location Address
First Line	:	1208 MYRTLE AVE
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79901-1602
Country	:	US
Telephone Number	:	915-351-8972
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	DR. JOSE LUNA JR.
Credential	:	MD
Telephone Number	:	915-225-0670

Provider Enumeration Date	:	07/25/2007
Last Update Date	:	04/30/2014

Similar Medicare Providers

1881685162 — THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Practice Location Address:

7304 GOOD SAMARITAN CT
EL PASO, TX
79912-1602

Practice Phone: 915-581-4683
Practice Fax: 915-581-5198

1356788897 — ST TERESA NURSING AND REHABILITATION CENTER, LLC
Practice Location Address:

10350 MONTANA AVENUE
EL PASO, TX
79925-1602

Practice Phone: 915-595-6137
Practice Fax: 915-595-6186

1043608169 — GOOD SAMARITAN SOCIETY HCBS-TX, LLC
Practice Location Address:

7304 GOOD SAMARITAN CT STE A
EL PASO, TX
79912-1602

Practice Phone: 915-533-0999
Practice Fax: 915-533-0997

1376927418 — GRUENEPOINTE 1 EL PASO, LLC
Practice Location Address:

10350 MONTANA AVE
EL PASO, TX
79925-1602

Practice Phone: 915-595-6137
Practice Fax:

1962902676 — ROXANA STUBBEMANN
Practice Location Address:

7304 GOOD SAMARITAN CT
EL PASO, TX
79912-1602

Practice Phone: 915-541-4683
Practice Fax:

1235630591 — SAMUEL J CHAVES
Practice Location Address:

7304 GOOD SAMARITAN CT
EL PASO, TX
79912-1602

Practice Phone: 575-993-9926
Practice Fax:

Directions to “CENTRO SAN VICENTE ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.