Provider Demographics
NPI:1588671853
Name:HORNEDO III, CARLOS N (DO)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:N
Last Name:HORNEDO III
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 WELBY CT
Mailing Address - Street 2:STE. 1
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-1951
Mailing Address - Country:US
Mailing Address - Phone:956-794-8840
Mailing Address - Fax:956-794-8844
Practice Address - Street 1:1203 WELBY CT
Practice Address - Street 2:STE. 1
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041
Practice Address - Country:US
Practice Address - Phone:956-794-8840
Practice Address - Fax:956-794-8844
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3242207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150778201Medicaid
TX150778202Medicaid
TX8686B0Medicare ID - Type UnspecifiedSOLO #
TX150778201Medicaid
TX00327TMedicare ID - Type UnspecifiedGROUP#