Provider Demographics
NPI:1225104292
Name:CITY OF EL PASO
Entity Type:Organization
Organization Name:CITY OF EL PASO
Other - Org Name:DEPT OF PUBLIC HEALTH-RAWLINGS DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CORTINAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-212-1067
Mailing Address - Street 1:110 CANDELARIA ST STE A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79907-5506
Mailing Address - Country:US
Mailing Address - Phone:915-212-7895
Mailing Address - Fax:
Practice Address - Street 1:3301 PERA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2313
Practice Address - Country:US
Practice Address - Phone:915-212-8000
Practice Address - Fax:915-212-0413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX143051223D0001X
1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120978504Medicaid
TX1209785-04Medicaid