Provider Demographics
NPI:1366264483
Name:BIG TREE MEDICAL OF EL PASO
Entity type:Organization
Organization Name:BIG TREE MEDICAL OF EL PASO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARIN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, CPNP-PC/A
Authorized Official - Phone:915-740-4344
Mailing Address - Street 1:5500 DONIPHAN DR STE 201-202
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79932-1454
Mailing Address - Country:US
Mailing Address - Phone:915-455-1119
Mailing Address - Fax:877-209-8941
Practice Address - Street 1:5500 DONIPHAN DR STE 201-202
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79932-1454
Practice Address - Country:US
Practice Address - Phone:915-455-1119
Practice Address - Fax:877-209-8941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No2080B0002XAllopathic & Osteopathic PhysiciansPediatricsObesity MedicineGroup - Multi-Specialty
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity MedicineGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty