Organization
EASTSIDE OCCMED CENTER, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. REBECCA AYERS (ADMIN ASSISTANT)
(915) 842-0504
Entity
Organization
Contact information
Practice address
1721 N LEE TREVINO DR, EL PASO, TX 79936-4521
(915) 590-9424
Mailing address
1721 N LEE TREVINO DR, PO BOX 12850, EL PASO, TX 79936-4521
(915) 590-9424
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
11/26/2007
Last updated
11/26/2007
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