Organization
PROJECT VIDA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JOSIE L MENDEZ (ASSISTANT BUSINESS MANAGER)
(915) 757-0038
Entity
Organization
Contact information
Practice address
3607 RIVERA AVE, EL PASO, TX 79905-2415
(915) 757-0038
(915) 757-1640
Mailing address
3612 PERA AVE, EL PASO, TX 79905-2412
(915) 533-7057
(915) 533-7197
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
PA03671
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA03671
PA LICENSE
TX
Enumeration date
03/09/2009
Last updated
03/09/2009
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