Provider Demographics
NPI:1134398530
Name:GUADALUPE MEDICAL CLINIC, PLLC
Entity type:Organization
Organization Name:GUADALUPE MEDICAL CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:FAMATIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-351-6100
Mailing Address - Street 1:1250 E CLIFF DR
Mailing Address - Street 2:SUITE 5A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4850
Mailing Address - Country:US
Mailing Address - Phone:915-351-6100
Mailing Address - Fax:915-351-6112
Practice Address - Street 1:1250 E CLIFF DR
Practice Address - Street 2:SUITE 5A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4850
Practice Address - Country:US
Practice Address - Phone:915-351-6100
Practice Address - Fax:915-351-6112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00744UMedicare PIN