Provider Demographics
NPI:1992147565
Name:SOUTHWEST PLASTIC SURGERY PA
Entity type:Organization
Organization Name:SOUTHWEST PLASTIC SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:J
Authorized Official - Last Name:AGULLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-590-7900
Mailing Address - Street 1:1387 GEORGE DIETER DR BLDG C301
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7410
Mailing Address - Country:US
Mailing Address - Phone:915-590-7900
Mailing Address - Fax:915-590-7902
Practice Address - Street 1:1387 GEORGE DIETER DR BLDG C301
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7410
Practice Address - Country:US
Practice Address - Phone:915-590-7900
Practice Address - Fax:915-590-7902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-24
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN84372086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty