Provider Demographics
NPI:1033532155
Name:CHACON, ARNOLDO N
Entity Type:Individual
Prefix:MR
First Name:ARNOLDO
Middle Name:N
Last Name:CHACON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:AMISTAD
Other - Middle Name:AMBULANCE
Other - Last Name:TRANSPORTS, LLC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3912 E HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-8810
Mailing Address - Country:US
Mailing Address - Phone:830-298-9796
Mailing Address - Fax:830-298-3040
Practice Address - Street 1:3912 E HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-8810
Practice Address - Country:US
Practice Address - Phone:830-298-9796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-24
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8001453416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182072201Medicaid
TXAMB522Medicare UPIN