Healthcare Provider Details

I. General information

NPI: 1881680155
Provider Name (Legal Business Name): EL PASO KIDNEY SPECIALISTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 BROWN ST
EL PASO TX
79902-4724
US

IV. Provider business mailing address

1601 BROWN ST
EL PASO TX
79902-4724
US

V. Phone/Fax

Practice location:
  • Phone: 915-544-4500
  • Fax: 915-544-4572
Mailing address:
  • Phone: 915-544-4500
  • Fax: 915-544-4572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number StateTX

VIII. Authorized Official

Name: MR. FERNANDO RAUDALES
Title or Position: MEDICAL DOCTOR PRESIDENT
Credential: MD
Phone: 915-544-4500