Healthcare Provider Details

I. General information

NPI: 1144570599
Provider Name (Legal Business Name): GUMMADI & DESAI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2717 MICHAEL ANGELO STE 302
EDINBURG TX
78539-1409
US

IV. Provider business mailing address

2717 MICHAEL ANGELO STE 302
EDINBURG TX
78539-1409
US

V. Phone/Fax

Practice location:
  • Phone: 956-668-1111
  • Fax:
Mailing address:
  • Phone: 956-668-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: SHANNON L LOPEZ
Title or Position: ADMIN
Credential:
Phone: 956-668-1111