=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043833767
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAUDI ALVARADO- ROBLES HIS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2020
-----------------------------------------------------
Last Update Date | 09/08/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1920 CORPORATE DR STE B205
-----------------------------------------------------
City | SAN MARCOS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78666-6287
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-667-6904
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3154 CHARYN WAY
-----------------------------------------------------
City | NEW BRAUNFELS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78132-0199
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-624-5205
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | 81092
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------