Provider Demographics
NPI:1780923482
Name:ALIVIO HEALTH CENTERS-LEE TREVINO
Entity type:Organization
Organization Name:ALIVIO HEALTH CENTERS-LEE TREVINO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALEJANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-356-4701
Mailing Address - Street 1:1331 N LEE TREVINO DR STE B
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-6475
Mailing Address - Country:US
Mailing Address - Phone:915-778-7778
Mailing Address - Fax:915-594-9991
Practice Address - Street 1:1331 N LEE TREVINO DR STE B
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6475
Practice Address - Country:US
Practice Address - Phone:915-778-7778
Practice Address - Fax:915-594-9991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization