Provider Demographics
NPI:1538547229
Name:MONDRAGON, KATIA C (FNP)
Entity type:Individual
Prefix:
First Name:KATIA
Middle Name:C
Last Name:MONDRAGON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2324 JACAMAN RD STE 201
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6201
Mailing Address - Country:US
Mailing Address - Phone:956-727-8760
Mailing Address - Fax:956-727-0504
Practice Address - Street 1:2324 JACAMAN RD STE 201
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6201
Practice Address - Country:US
Practice Address - Phone:956-727-8760
Practice Address - Fax:956-727-0504
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRN 708638363LF0000X
TXAP128193363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF0215137OtherCERTIFICATION
TXRN 708638OtherLICENSE