Healthcare Provider Details

I. General information

NPI: 1619589165
Provider Name (Legal Business Name): RAUL CAUDILLO FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 08/17/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8269 N LOOP DR
EL PASO TX
79907-4234
US

IV. Provider business mailing address

16023 HOMESTEAD DR
HORIZON CITY TX
79928-6524
US

V. Phone/Fax

Practice location:
  • Phone: 915-591-1615
  • Fax: 915-591-4100
Mailing address:
  • Phone: 915-356-0744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP146088
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: