Provider Demographics
NPI:1528165404
Name:DERMATOLOGY SPECIALISTS OF LAREDO PA
Entity type:Organization
Organization Name:DERMATOLOGY SPECIALISTS OF LAREDO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NEDIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALDARONDO-ANTONINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-729-7700
Mailing Address - Street 1:PO BOX 452409
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045
Mailing Address - Country:US
Mailing Address - Phone:956-729-7700
Mailing Address - Fax:
Practice Address - Street 1:2344 LAGUNA DEL MAR COURT
Practice Address - Street 2:SUITE 101
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045
Practice Address - Country:US
Practice Address - Phone:956-729-7700
Practice Address - Fax:956-729-7779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9972207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
8H9860OtherBC BS
TXP00116091OtherMEDICARE RAIL ROAD
TX00645UMedicare PIN
TXP00116091OtherMEDICARE RAIL ROAD