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Organization
SUN CITY SPORTS MEDICINE AND FAMILY CLINIC, PA
Active
Organization
SUN CITY SPORTS MEDICINE AND FAMILY CLINIC, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAURO PROVENCIO (MD/OWNER)
(915) 525-3209
Entity
Organization
Contact information
Practice address
12810 EDGEMERE BLVD, EL PASO, TX 79938-4532
(915) 504-6955
(915) 504-6954
Mailing address
12810 EDGEMERE BLVD, EL PASO, TX 79938-4532
(915) 222-8747
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
P1809
TX
Other
Enumeration date
06/07/2012
Last updated
06/18/2024
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