Healthcare Provider Details

I. General information

NPI: 1689007718
Provider Name (Legal Business Name): EAST-SIDE ONCOLOGY CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 01/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3022 TRAWOOD DR B
EL PASO TX
79936
US

IV. Provider business mailing address

3022 TRAWOOD DR B
EL PASO TX
79936
US

V. Phone/Fax

Practice location:
  • Phone: 915-849-1345
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberP2726
License Number StateTX

VIII. Authorized Official

Name: DR. NAGENDER MANKAN
Title or Position: OWNER
Credential:
Phone: 915-603-1242