Registry details
Type
Individual
Primary specialty
Internal Medicine
Enumerated
Oct 10, 2006
License(s)
MA64547 (NJ), MD2011-0215 (NM), MD2011-0215 (NM), N1507 (TX), MA64547 (NJ), N1507 (TX)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 12350 PASEO NUEVO DR | El Paso, TX 79928-5668 | 915-225-4470 |
| MAILING | PO BOX 972990 | El Paso, TX 79997-2990 | 915-225-4470 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.