Provider Demographics
NPI:1619589165
Name:CAUDILLO, RAUL (FNP)
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:
Last Name:CAUDILLO
Suffix:
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 1:16023 HOMESTEAD DR
Mailing Address - Street 2:
Mailing Address - City:HORIZON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79928-6524
Mailing Address - Country:US
Mailing Address - Phone:915-356-0744
Mailing Address - Fax:
Practice Address - Street 1:8269 N LOOP DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79907-4234
Practice Address - Country:US
Practice Address - Phone:915-591-1615
Practice Address - Fax:915-591-4100
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP146088363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily