Provider Demographics
NPI:1568196038
Name:YSLETA DEL SUR PUEBLO
Entity Type:Organization
Organization Name:YSLETA DEL SUR PUEBLO
Other - Org Name:YSLETA DEL SUR PUEBLO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:REASOL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-858-1076
Mailing Address - Street 1:9473 SOCORRO RD
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79907-6832
Mailing Address - Country:US
Mailing Address - Phone:915-858-1076
Mailing Address - Fax:915-232-9954
Practice Address - Street 1:9473 SOCORRO RD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79907
Practice Address - Country:US
Practice Address - Phone:915-858-1076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-12
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
No333600000XSuppliersPharmacy