Provider Demographics
NPI:1326027848
Name:NATIVIDAD, PEDRO JR (FNP)
Entity Type:Individual
Prefix:MR
First Name:PEDRO
Middle Name:
Last Name:NATIVIDAD
Suffix:JR
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4659 COHEN AVE
Mailing Address - Street 2:STE A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79924-4429
Mailing Address - Country:US
Mailing Address - Phone:915-881-3368
Mailing Address - Fax:915-751-0464
Practice Address - Street 1:4659 COHEN AVE
Practice Address - Street 2:STE A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-4429
Practice Address - Country:US
Practice Address - Phone:915-881-3368
Practice Address - Fax:915-751-0464
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP103563363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX317543YLPSOtherWELLMED PTAN
TXP01261192OtherMEDICARE RR
TX175112502Medicaid
TX175112502Medicaid
TX1751125-02Medicaid