Organization
PROJECT VIDA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RODRIGO CEBALLOS M.D. (MEDICAL DIRECTOR)
(512) 589-5519
Entity
Organization
Contact information
Practice address
3612 PERA AVE, EL PASO, TX 79905-2412
(915) 533-7057
(915) 533-7158
Mailing address
3612 PERA AVE, EL PASO, TX 79905-2412
(915) 533-7057
(915) 533-7158
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
678490
TX
Other
Enumeration date
09/14/2009
Last updated
09/14/2009
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