Provider Demographics
NPI:1437571114
Name:EL PASO INFECTIOUS DISEASES, PA
Entity Type:Organization
Organization Name:EL PASO INFECTIOUS DISEASES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN - OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GOUVEIA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:915-400-2600
Mailing Address - Street 1:1250 E CLIFF DR STE 5F
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4850
Mailing Address - Country:US
Mailing Address - Phone:915-400-2600
Mailing Address - Fax:915-249-4355
Practice Address - Street 1:1250 E CLIFF DR STE 5F
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4850
Practice Address - Country:US
Practice Address - Phone:915-400-2600
Practice Address - Fax:915-591-9215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-14
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8004207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM8004OtherTX MEDICAL LICENSE