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General NPI Number Information
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NPI Number | 1194707406
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Entity Type | Individual
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Provider Name | JITENDRA I VASANDANI MD
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Gender | Male
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Dates
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Enumeration Date | 11/14/2005
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Last Update Date | 03/01/2023
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Provider Practice Location Address
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Address Line | 10705 MILWAUKEE AVENUE
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City | LUBBOCK
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State | TX
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Zip | 78424
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Country | US
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Telephone | 806-701-5210
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Fax |
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Provider Business Mailing Address
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Address Line | 10705 MILWAUKEE AVE
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City | LUBBOCK
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State | TX
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Zip | 79424-6153
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Country | US
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Telephone | 806-744-7223
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Fax | 806-740-3325
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | K9691
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License Number State | TX
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