Provider Demographics
NPI:1740735588
Name:ALDRETE, JOSUE ISAI (PA)
Entity Type:Individual
Prefix:MR
First Name:JOSUE
Middle Name:ISAI
Last Name:ALDRETE
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:5460 PAREDES LINE RD
Mailing Address - Street 2:STE 200
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-9740
Mailing Address - Country:US
Mailing Address - Phone:956-554-0010
Mailing Address - Fax:956-554-3288
Practice Address - Street 1:5460 PAREDES LINE RD
Practice Address - Street 2:STE 200
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-9740
Practice Address - Country:US
Practice Address - Phone:956-554-0010
Practice Address - Fax:956-554-3288
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2016-11-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA10633363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX362274801Medicaid
TX531453YLPSOtherWELLMED PTAN