MEDICARE: LAKE HOUSTON ASTHMA ALLERGY IMMUNOLOGY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	M8597	TX

General Provider Information

NPI Number	:	1538452024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE HOUSTON ASTHMA ALLERGY IMMUNOLOGY

Provider Business Mailing Address
First Line	:	2311 RIVER VILLAGE DR
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-1835
Country	:	US
Telephone Number	:	281-825-2561
Fax Number	:

Provider Business Practice Location Address
First Line	:	5514 ATASCOCITA RD
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77346-2968
Country	:	US
Telephone Number	:	281-825-2561
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER
Name	:	JAVIER CHINEN
Credential	:
Telephone Number	:	281-825-2561

Provider Enumeration Date	:	05/17/2011
Last Update Date	:	05/17/2011

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