Provider Demographics
NPI:1063034221
Name:PREMIER PRIMARY CARE CLINIC LLC
Entity Type:Organization
Organization Name:PREMIER PRIMARY CARE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NP
Authorized Official - Prefix:
Authorized Official - First Name:KARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDOZA-MARCIAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-592-1531
Mailing Address - Street 1:10921 PELLICANO DR STE 121
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-4604
Mailing Address - Country:US
Mailing Address - Phone:915-320-7707
Mailing Address - Fax:915-892-1531
Practice Address - Street 1:10921 PELLICANO DR STE 121
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-4604
Practice Address - Country:US
Practice Address - Phone:915-320-7707
Practice Address - Fax:915-892-1531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-11
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care