Provider Demographics
NPI:1417723693
Name:EP MODERN MEDICINE PLLC
Entity Type:Organization
Organization Name:EP MODERN MEDICINE PLLC
Other - Org Name:EP PREVENTIVE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIBEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGALLANES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-228-3080
Mailing Address - Street 1:154 N FESTIVAL DR STE A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-6265
Mailing Address - Country:US
Mailing Address - Phone:915-328-6233
Mailing Address - Fax:915-779-9797
Practice Address - Street 1:154 N FESTIVAL DR STE A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-6265
Practice Address - Country:US
Practice Address - Phone:915-328-6233
Practice Address - Fax:915-779-9797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-29
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty