Provider Demographics
NPI:1225398837
Name:PRUNEDA, RAYMOND ROY (FITTER & DISPENSER)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:ROY
Last Name:PRUNEDA
Suffix:
Gender:M
Credentials:FITTER & DISPENSER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 S CLOSNER BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-5642
Mailing Address - Country:US
Mailing Address - Phone:956-533-0594
Mailing Address - Fax:956-386-9097
Practice Address - Street 1:922 S CLOSNER BLVD STE A
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-5642
Practice Address - Country:US
Practice Address - Phone:956-533-0594
Practice Address - Fax:956-386-9097
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80429237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX382064901Medicaid
TX288604603Medicaid