Provider Demographics
NPI:1942391677
Name:RIO GRANDE HEALTH CENTER OF EL PASO INC
Entity type:Organization
Organization Name:RIO GRANDE HEALTH CENTER OF EL PASO INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:TREJO
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:915-599-1119
Mailing Address - Street 1:7230 GATEWAY E
Mailing Address - Street 2:STE E
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79915-1353
Mailing Address - Country:US
Mailing Address - Phone:915-599-1119
Mailing Address - Fax:915-592-9334
Practice Address - Street 1:7230 GATEWAY E
Practice Address - Street 2:STE E
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915-1353
Practice Address - Country:US
Practice Address - Phone:915-599-1119
Practice Address - Fax:915-592-9334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty