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General NPI Number Information
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NPI Number | 1558943241
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Entity Type | Individual
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Provider Name | JITHENDHAR KANDIMALLA MD
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Gender | Male
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Dates
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Enumeration Date | 04/22/2021
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 4801 ALBERTA AVE
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City | EL PASO
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State | TX
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Zip | 79905-2707
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Country | US
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Telephone | 915-215-5900
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Fax | 915-215-8615
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Provider Business Mailing Address
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Address Line | 5130 GATEWAY BLVD E
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City | EL PASO
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State | TX
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Zip | 79905-1608
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Country | US
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Telephone | 915-215-4480
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Fax | 915-215-5386
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | V5291
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License Number State | TX
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