Healthcare Provider Details

I. General information

NPI: 1699815944
Provider Name (Legal Business Name): EL PASO NEUROSURGERY CENTER, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 VISTA DEL SOL DR SUITE 104
EL PASO TX
79925-7945
US

IV. Provider business mailing address

10400 VISTA DEL SOL DR SUITE 104
EL PASO TX
79925-7945
US

V. Phone/Fax

Practice location:
  • Phone: 915-590-1890
  • Fax: 915-590-1952
Mailing address:
  • Phone: 915-590-1890
  • Fax: 915-590-1952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberL2019
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberL2019
License Number StateTX

VIII. Authorized Official

Name: DR. SHANKER SUNDRANI
Title or Position: OWNER
Credential: M.D.
Phone: 915-590-1890