Healthcare Provider Details

I. General information

NPI: 1467395673
Provider Name (Legal Business Name): NIKITA GUNTUBOINA MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 RICK FRANCIS ST
EL PASO TX
79905-2841
US

IV. Provider business mailing address

130 RICK FRANCIS ST MSC 41007
EL PASO TX
79905-2841
US

V. Phone/Fax

Practice location:
  • Phone: 915-215-5200
  • Fax: 915-215-8640
Mailing address:
  • Phone: 915-215-5200
  • Fax: 915-215-8640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP10099258
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: