Provider Demographics
NPI:1639577315
Name:CORCHADO, EDMUNDO (LPOA)
Entity type:Individual
Prefix:
First Name:EDMUNDO
Middle Name:
Last Name:CORCHADO
Suffix:
Gender:M
Credentials:LPOA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6219 LOS ALTOS DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-2509
Mailing Address - Country:US
Mailing Address - Phone:915-204-0448
Mailing Address - Fax:
Practice Address - Street 1:1302 N STANTON ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4122
Practice Address - Country:US
Practice Address - Phone:915-532-4444
Practice Address - Fax:915-534-7626
Is Sole Proprietor?:No
Enumeration Date:2014-12-12
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1263222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist