Provider Demographics
NPI:1700812948
Name:GARDUNO, CLAUDIA MIRIAM (MPT)
Entity Type:Individual
Prefix:MS
First Name:CLAUDIA
Middle Name:MIRIAM
Last Name:GARDUNO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:CLAUDIA
Other - Middle Name:MIRIAM
Other - Last Name:CARRANZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:2320 MURCHISON DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79930-1106
Mailing Address - Country:US
Mailing Address - Phone:915-533-1007
Mailing Address - Fax:
Practice Address - Street 1:6358 EDGEMERE BLVD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-3517
Practice Address - Country:US
Practice Address - Phone:915-562-8525
Practice Address - Fax:915-566-3889
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1155660225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B8300Medicare PIN