Provider Demographics
NPI:1144411901
Name:TEXAS TECH UNIVERSITY
Entity Type:Organization
Organization Name:TEXAS TECH UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN IN TRAINING
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:CARDENTEY
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:915-581-3830
Mailing Address - Street 1:205 DE LEON DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-4543
Mailing Address - Country:US
Mailing Address - Phone:915-581-3830
Mailing Address - Fax:
Practice Address - Street 1:9849 KENWORTHY ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-4402
Practice Address - Country:US
Practice Address - Phone:915-757-3178
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23410660985261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care