Healthcare Provider Details

I. General information

NPI: 1992013015
Provider Name (Legal Business Name): GAITHRI ARUNESH VIVEKANANTHAN P.A.-C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2010
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6124 W PARKER RD SUITE 530
PLANO TX
75093-8122
US

IV. Provider business mailing address

6124 W PARKER RD SUITE 530
PLANO TX
75093-8122
US

V. Phone/Fax

Practice location:
  • Phone: 214-778-1075
  • Fax: 214-778-1237
Mailing address:
  • Phone: 214-778-1075
  • Fax: 214-778-1237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA07076
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA07676
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: