Provider Demographics
NPI:1982656534
Name:JAIN, AVANINDRA
Entity Type:Individual
Prefix:DR
First Name:AVANINDRA
Middle Name:
Last Name:JAIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17218 EAGLE HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-1554
Mailing Address - Country:US
Mailing Address - Phone:210-492-2958
Mailing Address - Fax:
Practice Address - Street 1:2455 NE LOOP 410
Practice Address - Street 2:SUITE NUMBER 235
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5649
Practice Address - Country:US
Practice Address - Phone:210-637-0091
Practice Address - Fax:210-637-0095
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0539174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F0163Medicare ID - Type Unspecified
TXC84698Medicare UPIN