Provider Demographics
NPI:1649411463
Name:PROJECT VIDA
Entity Type:Organization
Organization Name:PROJECT VIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOSIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-757-0038
Mailing Address - Street 1:3612 PERA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-2412
Mailing Address - Country:US
Mailing Address - Phone:915-533-7057
Mailing Address - Fax:915-533-7197
Practice Address - Street 1:3607 RIVERA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2415
Practice Address - Country:US
Practice Address - Phone:915-757-0038
Practice Address - Fax:915-757-1640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03671261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA03671OtherPA LICENSE