Healthcare Provider Details

I. General information

NPI: 1164544805
Provider Name (Legal Business Name): CARLOS. N. HORNEDO III, D.O. PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 08/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 WELBY COURT STE 1
LAREDO TX
78041
US

IV. Provider business mailing address

1203 WELBY COURT STE 1
LAREDO TX
78041
US

V. Phone/Fax

Practice location:
  • Phone: 956-794-8840
  • Fax: 956-794-8844
Mailing address:
  • Phone: 956-794-8840
  • Fax: 956-794-8844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberK3242
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberK3242
License Number StateTX

VIII. Authorized Official

Name: RAQUEL MARQUEZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 956-794-8840