Provider Demographics
NPI:1093001265
Name:EL PASO RIO GRANDE OB/GYN, PA
Entity Type:Organization
Organization Name:EL PASO RIO GRANDE OB/GYN, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-533-7579
Mailing Address - Street 1:125 W HAGUE RD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5814
Mailing Address - Country:US
Mailing Address - Phone:915-533-7579
Mailing Address - Fax:915-225-3832
Practice Address - Street 1:125 W HAGUE RD
Practice Address - Street 2:SUITE 260
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5814
Practice Address - Country:US
Practice Address - Phone:915-533-7579
Practice Address - Fax:915-225-3832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-25
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8442207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2840621-01Medicaid
TX801440526OtherSTATE PA FILING #
TX801440526OtherSTATE PA FILING #