Provider Demographics
NPI:1881680155
Name:EL PASO KIDNEY SPECIALISTS PA
Entity Type:Organization
Organization Name:EL PASO KIDNEY SPECIALISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:RAUDALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-544-4500
Mailing Address - Street 1:1310 MURCHISON DR STE 100
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4821
Mailing Address - Country:US
Mailing Address - Phone:915-544-4500
Mailing Address - Fax:915-546-9430
Practice Address - Street 1:1310 MURCHISON DR STE 100
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902
Practice Address - Country:US
Practice Address - Phone:915-544-4500
Practice Address - Fax:915-544-4572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161379601Medicaid
00706VMedicare ID - Type Unspecified