Healthcare Provider Details

I. General information

NPI: 1275853343
Provider Name (Legal Business Name): ACUTE ALLERGY ASTHMA AND IMMUNOLOGY OF ATHERTON, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 07/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 EL CAMINO REAL SUITE 101
ATHERTON CA
94027-3812
US

IV. Provider business mailing address

3301 EL CAMINO REAL SUITE 101
ATHERTON CA
94027-3812
US

V. Phone/Fax

Practice location:
  • Phone: 650-559-9577
  • Fax: 650-556-0655
Mailing address:
  • Phone: 650-556-9577
  • Fax: 650-556-0655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberG84174
License Number StateCA

VIII. Authorized Official

Name: MANJUL S DIXIT
Title or Position: PRESIDENT
Credential: MD
Phone: 650-814-2423