Provider Demographics
NPI:1790230738
Name:IGLESIAS FAMILY MEDICINE PA
Entity Type:Organization
Organization Name:IGLESIAS FAMILY MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:IGLESIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-702-0030
Mailing Address - Street 1:1011 MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5411
Mailing Address - Country:US
Mailing Address - Phone:915-702-0030
Mailing Address - Fax:
Practice Address - Street 1:9895 ALAMEDA AVE
Practice Address - Street 2:SUITE 118
Practice Address - City:SOCORRO
Practice Address - State:TX
Practice Address - Zip Code:79927-2833
Practice Address - Country:US
Practice Address - Phone:915-702-0030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty