Provider Demographics
NPI:1497908958
Name:PRUNEDA, MIKE ANGEL SR
Entity Type:Individual
Prefix:MR
First Name:MIKE
Middle Name:ANGEL
Last Name:PRUNEDA
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 E EXPRESSWAY 83 STE T
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-6505
Mailing Address - Country:US
Mailing Address - Phone:956-702-7777
Mailing Address - Fax:956-702-7773
Practice Address - Street 1:216 E EXPRESSWAY 83 STE T
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-6505
Practice Address - Country:US
Practice Address - Phone:956-702-7777
Practice Address - Fax:956-702-7773
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50670237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist