=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467463562
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VIOLETA RADENOVICH M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2006
-----------------------------------------------------
Last Update Date | 02/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1250 E CLIFF DR STE 4D
-----------------------------------------------------
City | EL PASO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79902-4846
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-577-9339
-----------------------------------------------------
Fax | 915-541-1237
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1250 E CLIFF DR STE 4D
-----------------------------------------------------
City | EL PASO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79902-4846
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-577-9339
-----------------------------------------------------
Fax | 915-541-1237
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 202D00000X
-----------------------------------------------------
Taxonomy Name | Integrative Medicine Physician
-----------------------------------------------------
License Number | K0160
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | K0160
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207WX0110X
-----------------------------------------------------
Taxonomy Name | Pediatric Ophthalmology and Strabismus Specialist Physician Physician
-----------------------------------------------------
License Number | K0160
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------