Healthcare Provider Details

I. General information

NPI: 1477692465
Provider Name (Legal Business Name): ALDO R MASPONS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 03/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E SCHUSTER AVE
EL PASO TX
79902-3556
US

IV. Provider business mailing address

5959 GATEWAY BLVD W SUITE 120
EL PASO TX
79925-3331
US

V. Phone/Fax

Practice location:
  • Phone: 915-929-7363
  • Fax: 831-627-7667
Mailing address:
  • Phone: 915-779-1716
  • Fax: 915-771-6496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberP4349
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2006-0350
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: