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General NPI Number Information
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NPI Number | 1396442869
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Entity Type | Organization
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Legal Business Name | JITENDRA VASANDANI, MD PA
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Dates
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Enumeration Date | 02/14/2023
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Last Update Date | 02/14/2023
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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 | 79424-6153
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Country | US
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Telephone | 806-740-3325
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Fax |
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Provider Business Mailing 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 | 79424-6153
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Country | US
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Telephone | 806-744-7223
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | BIANCA WILLIAMS
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Credential |
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Telephone | 561-320-0993
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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 |
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License Number State |
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