Provider Demographics
NPI:1649815978
Name:MADRID, ALFREDO JR (APRN)
Entity type:Individual
Prefix:MR
First Name:ALFREDO
Middle Name:
Last Name:MADRID
Suffix:JR
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 GERONIMO DRIVE, BUILDING C
Mailing Address - Street 2:SUITE B
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-1855
Mailing Address - Country:US
Mailing Address - Phone:915-343-9702
Mailing Address - Fax:915-277-8661
Practice Address - Street 1:1420 GERONIMO DR STE C
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-1855
Practice Address - Country:US
Practice Address - Phone:915-343-9702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-11
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2019055884363L00000X
TXAP144538363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner