Basic Information
| Provider Information | |||||||||
| NPI: | 1720219637 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MADERO GOROSTIETA | ||||||||
| FirstName: | FERNANDO | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11511 SHADOW CREEK PKWY | ||||||||
| Address2: | |||||||||
| City: | PEARLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775847298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134424997 | ||||||||
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| Practice Location | |||||||||
| Address1: | 920 MEDICAL PLAZA DR | ||||||||
| Address2: | |||||||||
| City: | SHENANDOAH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773803260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138972300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2009 | ||||||||
| LastUpdateDate: | 05/06/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | S7490 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 251415 | MA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 251415 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.