Provider Demographics
NPI:1245578830
Name:CORE WELLNESS AND REHABILITATION CLINIC
Entity Type:Organization
Organization Name:CORE WELLNESS AND REHABILITATION CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT
Authorized Official - Prefix:MISS
Authorized Official - First Name:LYNNETTE
Authorized Official - Middle Name:S
Authorized Official - Last Name:LOMARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-474-0390
Mailing Address - Street 1:6730 CAPITAN RDG
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-8139
Mailing Address - Country:US
Mailing Address - Phone:915-474-0390
Mailing Address - Fax:915-581-5391
Practice Address - Street 1:6730 CAPITAN RDG
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-8139
Practice Address - Country:US
Practice Address - Phone:915-474-0390
Practice Address - Fax:915-581-5391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1076743174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty