Provider Demographics
NPI:1588951800
Name:RINCON, JOSE L (PAC)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:L
Last Name:RINCON
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4815 EXCALIBUR DR #A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-1203
Mailing Address - Country:US
Mailing Address - Phone:915-203-1465
Mailing Address - Fax:
Practice Address - Street 1:4815 EXCALIBUR DR # A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-1203
Practice Address - Country:US
Practice Address - Phone:915-203-1465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07463363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM61283851Medicaid
TX297283801Medicaid
NM61283851Medicaid