MEDICARE: MR. PEDRO NATIVIDAD JR. FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP103563	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01261192	OTHER	TX	MEDICARE RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	317543YLPS	OTHER	TX	WELLMED PTAN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326027848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PEDRO NATIVIDAD JR. FNP

Provider Business Mailing Address
First Line	:	4659 COHEN AVE UNIT A
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79924-4430
Country	:	US
Telephone Number	:	915-881-3368
Fax Number	:	915-751-0464

Provider Business Practice Location Address
First Line	:	11450 GATEWAY BLVD N STE 1100
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79934-3460
Country	:	US
Telephone Number	:	915-271-4635
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	10/03/2025

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