Organization
PROVENCIO ENTERPRISES INCORPORATED
Active
Organization
PROVENCIO ENTERPRISES INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRISELDA P OAXACA (OWNER/DIRECTOR)
(915) 613-3989
Entity
Organization
Contact information
Practice address
5380 N MESA ST STE 108, EL PASO, TX 79912-5869
(915) 613-3989
(915) 503-2737
Mailing address
5380 N MESA ST STE 108, EL PASO, TX 79912-5869
(915) 613-3989
(915) 503-2737
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
10/02/2018
Last updated
10/02/2018
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