Organization
CGN EPENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH GONZALES (BILLING/CREDENTIALING SUPERVISOR)
(915) 779-5866
Entity
Organization
Contact information
Practice address
5959 GATEWAY BLVD W STE 160, EL PASO, TX 79925-3315
(915) 779-5866
Mailing address
5959 GATEWAY BLVD W STE 160, EL PASO, TX 79925-3315
(915) 779-5866
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
118690001
—
TX
05
—
153157602
—
TX
05
—
326176001
—
TX
Enumeration date
10/09/2020
Last updated
12/01/2020
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