Basic Information
Provider Information
NPI: 1336664044
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VAINSENCHER
FirstName: DAVID
MiddleName:  
NamePrefix: MR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3607 RIVERA AVE
Address2:  
City: EL PASO
State: TX
PostalCode: 799052415
CountryCode: US
TelephoneNumber: 9155337057
FaxNumber:  
Practice Location
Address1: 3607 RIVERA AVE
Address2:  
City: EL PASO
State: TX
PostalCode: 799052415
CountryCode: US
TelephoneNumber: 9155337057
FaxNumber: 9155337057
Other Information
ProviderEnumerationDate: 08/03/2017
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207N00000XG0889TXY Allopathic & Osteopathic PhysiciansDermatology 

No ID Information.


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