Provider Demographics
NPI:1104105089
Name:RANGEL, ELEAZAR (RRTS)
Entity type:Individual
Prefix:
First Name:ELEAZAR
Middle Name:
Last Name:RANGEL
Suffix:
Gender:M
Credentials:RRTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 AIRPORT RD STE H
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-1049
Mailing Address - Country:US
Mailing Address - Phone:915-532-4555
Mailing Address - Fax:915-562-7609
Practice Address - Street 1:6400 AIRPORT RD STE H
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-1049
Practice Address - Country:US
Practice Address - Phone:915-532-4555
Practice Address - Fax:915-562-7609
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1009261332BC3200X, 247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other