# EASTSIDE OCCMED CENTER, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497936959
- **Authorized official:** MRS. REBECCA AYERS (ADMIN ASSISTANT)
- **Authorized official phone:** (915) 842-0504

## Contact information

- **Practice address:** 1721 N LEE TREVINO DR, EL PASO, TX 79936-4521
- **Practice address phone:** (915) 590-9424
- **Mailing address:** 1721 N LEE TREVINO DR, PO BOX 12850, EL PASO, TX 79936-4521
- **Mailing address phone:** (915) 590-9424

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/26/2007
- **Last updated:** 11/26/2007