Provider Demographics
NPI:1326020140
Name:EL PASO CARDIAC VASCULAR & THORACIC SURGEONS PA
Entity Type:Organization
Organization Name:EL PASO CARDIAC VASCULAR & THORACIC SURGEONS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:HUMBERTO
Authorized Official - Last Name:CORRAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-542-0400
Mailing Address - Street 1:1700 N OREGON ST
Mailing Address - Street 2:STE 750
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-3584
Mailing Address - Country:US
Mailing Address - Phone:915-542-0400
Mailing Address - Fax:915-542-1188
Practice Address - Street 1:1700 N OREGON ST
Practice Address - Street 2:STE 750
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3584
Practice Address - Country:US
Practice Address - Phone:915-542-0400
Practice Address - Fax:915-542-1188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0049AUOtherBCBS
NM000X3247OtherSALUD PROGRAMS MEDICAID
TX0049AUMedicare ID - Type Unspecified