Provider Demographics
NPI:1801018395
Name:DESERT MOUNTAIN OBSTETRICS & GYNECOLOGY P A
Entity Type:Organization
Organization Name:DESERT MOUNTAIN OBSTETRICS & GYNECOLOGY P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:JUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-545-1200
Mailing Address - Street 1:1201 E SCHUSTER AVE STE 5A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4658
Mailing Address - Country:US
Mailing Address - Phone:915-545-1200
Mailing Address - Fax:915-545-1363
Practice Address - Street 1:1201 E SCHUSTER AVE STE 5A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4658
Practice Address - Country:US
Practice Address - Phone:915-545-1200
Practice Address - Fax:915-545-1363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8177207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0027GWOtherBCBSTX
NML4056OtherACS NM
TX100208101Medicaid
NM201012673OtherPRESBYTERIAN SALUD
NM201012673OtherPRESBYTERIAN SALUD
TX=========OtherACCESS ADMINISTRATORS
NM201012673OtherPRESBYTERIAN SALUD
TX100208101Medicaid