Provider Demographics
NPI:1841336716
Name:CHILDREN'S CLINIC OF EL PASO
Entity type:Organization
Organization Name:CHILDREN'S CLINIC OF EL PASO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:AZARCON-SAMONTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-592-2600
Mailing Address - Street 1:11544 VISTA DEL SOL
Mailing Address - Street 2:BLDG. A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936
Mailing Address - Country:US
Mailing Address - Phone:915-592-2600
Mailing Address - Fax:915-592-3733
Practice Address - Street 1:11544 VISTA DEL SOL
Practice Address - Street 2:BLDG. A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936
Practice Address - Country:US
Practice Address - Phone:915-592-2600
Practice Address - Fax:915-592-3733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9960208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092123101Medicaid