Provider Demographics
NPI:1467463562
Name:RADENOVICH, VIOLETA (MD)
Entity Type:Individual
Prefix:DR
First Name:VIOLETA
Middle Name:
Last Name:RADENOVICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 E CLIFF DR STE 4D
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4846
Mailing Address - Country:US
Mailing Address - Phone:915-577-9339
Mailing Address - Fax:915-541-1237
Practice Address - Street 1:1250 E CLIFF DR STE 4D
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4846
Practice Address - Country:US
Practice Address - Phone:915-577-9339
Practice Address - Fax:915-541-1237
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0160207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK0160OtherLICENSE
TXK0160OtherLICENSE
TXK0160OtherLICENSE
TX126563-02Medicaid