Provider Demographics
NPI:1649404864
Name:EL PASO CHILD NEUROLOGY PA
Entity Type:Organization
Organization Name:EL PASO CHILD NEUROLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORENL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-772-9816
Mailing Address - Street 1:1900 N OREGON ST
Mailing Address - Street 2:520
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-3351
Mailing Address - Country:US
Mailing Address - Phone:408-772-9816
Mailing Address - Fax:915-591-9215
Practice Address - Street 1:1900 N OREGON ST
Practice Address - Street 2:520
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3351
Practice Address - Country:US
Practice Address - Phone:408-772-9816
Practice Address - Fax:915-591-9215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN26732080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental DisabilitiesGroup - Single Specialty