=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912274853
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VIOLETA RADENOVICH, MD, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2011
-----------------------------------------------------
Last Update Date | 11/21/2011
-----------------------------------------------------
=====================================================
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 | OFFICE ADMINISTRATOR
-----------------------------------------------------
Name | CATHERINE HAMPEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 915-577-9339
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number | K0160
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------