Organization
EL PASO CENTER FOR PEDIATRIC GASTROENTEROLOGY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIDINE CO MD (PRESIDENT)
(915) 269-0064
Entity
Organization
Contact information
Practice address
2311 N MESA ST STE C, EL PASO, TX 79902-3575
(915) 269-0064
Mailing address
2311 N MESA ST STE C, EL PASO, TX 79902-3575
(915) 269-0064
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
—
—
2080P0206X
Pediatric Gastroenterology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
384898803
—
TX
Enumeration date
09/10/2018
Last updated
09/22/2020
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