Provider Demographics
NPI:1962082891
Name:CANTO ARGUELLES, KORAIMA (PA)
Entity type:Individual
Prefix:
First Name:KORAIMA
Middle Name:
Last Name:CANTO ARGUELLES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 TENAZA DR
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-4695
Mailing Address - Country:US
Mailing Address - Phone:956-309-2652
Mailing Address - Fax:
Practice Address - Street 1:800 E ALTON GLOOR BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-4248
Practice Address - Country:US
Practice Address - Phone:956-518-7444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14408363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant