Provider Demographics
NPI:1629425145
Name:AMISTAD PERSONAL ASSISTANT SERVICES
Entity Type:Organization
Organization Name:AMISTAD PERSONAL ASSISTANT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVA
Authorized Official - Middle Name:VERONICA
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-526-8038
Mailing Address - Street 1:11965 CROWN ROYAL DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-0619
Mailing Address - Country:US
Mailing Address - Phone:915-526-8038
Mailing Address - Fax:915-921-7335
Practice Address - Street 1:11965 CROWN ROYAL DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-0619
Practice Address - Country:US
Practice Address - Phone:915-526-8038
Practice Address - Fax:915-921-7335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care