Healthcare Provider Details

I. General information

NPI: 1396131819
Provider Name (Legal Business Name): DR. PRASHANT JHA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2015
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4845 ALAMEDA AVE
EL PASO TX
79905-2705
US

IV. Provider business mailing address

5130 GATEWAY BLVD E
EL PASO TX
79905-1608
US

V. Phone/Fax

Practice location:
  • Phone: 915-215-5700
  • Fax: 915-215-8872
Mailing address:
  • Phone: 915-215-4480
  • Fax: 915-215-5386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberD0104428
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberW0425
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number19105
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberW0425
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: