Provider Demographics
NPI:1275141319
Name:JOSE A BARAHONA MD PLLC
Entity Type:Organization
Organization Name:JOSE A BARAHONA MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BARAHONA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-849-0243
Mailing Address - Street 1:1500 FINSTERWALD PL
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-6011
Mailing Address - Country:US
Mailing Address - Phone:915-849-0243
Mailing Address - Fax:
Practice Address - Street 1:10501 VISTA DEL SOL DR STE 110
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7941
Practice Address - Country:US
Practice Address - Phone:915-849-0243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-15
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK1353OtherTEXAS LICENSE