MEDICARE: MARGARITA MADRID PNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	1018037	TX

General Provider Information

NPI Number	:	1831799857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGARITA MADRID PNP-BC

Provider Business Mailing Address
First Line	:	14100 SAN PEDRO AVE STE 412
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-2009
Country	:	US
Telephone Number	:	210-281-8669
Fax Number	:	210-314-5044

Provider Business Practice Location Address
First Line	:	10325 LAKE JUNE RD STE 568
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75217-5326
Country	:	US
Telephone Number	:	214-247-6550
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2020
Last Update Date	:	11/29/2022

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