Healthcare Provider Details

I. General information

NPI: 1154313898
Provider Name (Legal Business Name): VISHAN GIYANANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 10/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 E YANDELL DR
EL PASO TX
79903-3616
US

IV. Provider business mailing address

2415 E YANDELL DR
EL PASO TX
79903-3616
US

V. Phone/Fax

Practice location:
  • Phone: 915-577-0111
  • Fax: 915-533-2568
Mailing address:
  • Phone: 915-577-0111
  • Fax: 915-533-2568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG7813
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: