Provider Demographics
NPI:1124371588
Name:DEDICATED MEDICAL PROFESSIONAL MANAGEMENT LLC
Entity type:Organization
Organization Name:DEDICATED MEDICAL PROFESSIONAL MANAGEMENT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWING
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-630-6972
Mailing Address - Street 1:1515 CESSNA DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-2555
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1515 CESSNA DR
Practice Address - Street 2:SUITE 103
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-2555
Practice Address - Country:US
Practice Address - Phone:915-630-6972
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-23
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)