Healthcare Provider Details

I. General information

NPI: 1770069569
Provider Name (Legal Business Name): RAWAN SHARMA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2018
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 ALBERTA AVE
EL PASO TX
79905-2707
US

IV. Provider business mailing address

185 S ORANGE AVE BLDG G-538
NEWARK NJ
07103-2757
US

V. Phone/Fax

Practice location:
  • Phone: 915-215-4460
  • Fax:
Mailing address:
  • Phone: 739-724-4179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP10100857
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: