Provider Demographics
NPI:1114385150
Name:DONIPHAN PEDIATRICS PA
Entity Type:Organization
Organization Name:DONIPHAN PEDIATRICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCES MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:VALERIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LARIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-642-4117
Mailing Address - Street 1:6621 DONIPHAN DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:CANUTILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79835-5002
Mailing Address - Country:US
Mailing Address - Phone:915-642-4117
Mailing Address - Fax:915-642-4113
Practice Address - Street 1:6621 DONIPHAN DR
Practice Address - Street 2:SUITE E
Practice Address - City:CANUTILLO
Practice Address - State:TX
Practice Address - Zip Code:79835-5002
Practice Address - Country:US
Practice Address - Phone:915-642-4117
Practice Address - Fax:915-642-4113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health