Provider Demographics
NPI:1487790176
Name:DIABETES RELATED EDUCATION & MGMT
Entity type:Organization
Organization Name:DIABETES RELATED EDUCATION & MGMT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EUSTACIO
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-772-2007
Mailing Address - Street 1:1576 LOMALAND DR STE B-1
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-4202
Mailing Address - Country:US
Mailing Address - Phone:915-772-2007
Mailing Address - Fax:915-772-2407
Practice Address - Street 1:1576 LOMALAND DR STE B-1
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-4202
Practice Address - Country:US
Practice Address - Phone:915-772-2007
Practice Address - Fax:915-772-2407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX580093Medicare ID - Type UnspecifiedDIABETES RELATED EDUC. &
TX00184HMedicare ID - Type UnspecifiedGARIMA