Provider Demographics
NPI:1346243235
Name:ARMENDARIZ, RAFAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:
Last Name:ARMENDARIZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 GERONIMO DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-1836
Mailing Address - Country:US
Mailing Address - Phone:915-591-2704
Mailing Address - Fax:915-225-0413
Practice Address - Street 1:6974 GATEWAY BLVD E
Practice Address - Street 2:STE F
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915-1115
Practice Address - Country:US
Practice Address - Phone:915-774-8850
Practice Address - Fax:915-598-3946
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9953207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111753303Medicaid
TX111753302Medicaid
TX111753303Medicaid
TX111753302Medicaid