Provider Demographics
NPI:1508406869
Name:PANIAMONT PLLC
Entity Type:Organization
Organization Name:PANIAMONT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PANIAGUA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-321-5057
Mailing Address - Street 1:6017 OJO DE AGUA DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-7503
Mailing Address - Country:US
Mailing Address - Phone:915-321-5057
Mailing Address - Fax:
Practice Address - Street 1:6000 NORTHERN PASS DR STE B-2
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79911-7206
Practice Address - Country:US
Practice Address - Phone:915-321-5057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty