MEDICARE: ALFREDO MADRID PLLC

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
2	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1427897834
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALFREDO MADRID PLLC

Provider Business Mailing Address
First Line	:	1420 GERONIMO DRIVE
Second Line	:	BUILDING C, SUITE B
City	:	EL PASO
State	:	TX
Zip	:	79925-1855
Country	:	US
Telephone Number	:	915-343-9702
Fax Number	:	915-277-8661

Provider Business Practice Location Address
First Line	:	1420 GERONIMO DRIVE
Second Line	:	BUILDING C, SUITE B
City	:	EL PASO
State	:	TX
Zip	:	79925-1855
Country	:	US
Telephone Number	:	915-343-9702
Fax Number	:	915-277-8661

Authorized Official
Title or Position	:	NURSE PRACTITIONER/ OWNER
Name	:	ALFREDO MADRID
Credential	:	FNP-BC
Telephone Number	:	915-343-9702

Provider Enumeration Date	:	05/23/2024
Last Update Date	:	07/14/2025

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