Provider Demographics
NPI:1710978572
Name:TERESA R PINAROC MD PA
Entity Type:Organization
Organization Name:TERESA R PINAROC MD PA
Other - Org Name:SUN VALLEY MEDICAL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:RUBIO
Authorized Official - Last Name:PINAROC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-613-3741
Mailing Address - Street 1:PO BOX 961509
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79996-1509
Mailing Address - Country:US
Mailing Address - Phone:915-613-3741
Mailing Address - Fax:915-594-0566
Practice Address - Street 1:11548 VISTA DEL SOL DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936
Practice Address - Country:US
Practice Address - Phone:915-613-3741
Practice Address - Fax:915-594-0566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4983207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0022JLOtherBLUE CROSS BLUE SHIELD TX
TX5916252OtherAETNA
TX110244615OtherRAILROAD MEDICARE
TX154040301Medicaid
TX08390465OtherEL PASO FIRST HEALTH PLAN
TX8A0578OtherMEDICARE,INDIVIDUAL
TX========= 0004OtherCIGNA
TX5916252OtherAETNA
TX========= 0004OtherCIGNA