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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