Provider Demographics
NPI:1205939600
Name:WEST TEXAS CHILDRENS CANCER & BLOOD DISORDERS PA
Entity type:Organization
Organization Name:WEST TEXAS CHILDRENS CANCER & BLOOD DISORDERS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-541-8903
Mailing Address - Street 1:125 W HAGUE
Mailing Address - Street 2:STE 500
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902
Mailing Address - Country:US
Mailing Address - Phone:915-541-8903
Mailing Address - Fax:915-313-0125
Practice Address - Street 1:125 W HAGUE
Practice Address - Street 2:STE 500
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902
Practice Address - Country:US
Practice Address - Phone:915-541-8903
Practice Address - Fax:915-313-0125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ08812080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX12555305OtherIND MCD
NM70187Medicaid
TX00731UMedicare ID - Type Unspecified
NM70187Medicaid
TX12555305OtherIND MCD