Provider Demographics
NPI:1265922876
Name:OCCMED CENTERS OF EL PASO, PA
Entity type:Organization
Organization Name:OCCMED CENTERS OF EL PASO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANOUCHEHR
Authorized Official - Middle Name:
Authorized Official - Last Name:REFAEIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-593-9300
Mailing Address - Street 1:311 CAMINO ESTANCIAS
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-3424
Mailing Address - Country:US
Mailing Address - Phone:915-593-9300
Mailing Address - Fax:915-593-9310
Practice Address - Street 1:311 CAMINO ESTANCIAS
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-3424
Practice Address - Country:US
Practice Address - Phone:915-593-9300
Practice Address - Fax:915-593-9310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ66842081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty