Healthcare Provider Details

I. General information

NPI: 1982951208
Provider Name (Legal Business Name): ALLERGY AND ASTHMA CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 08/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 MAIN ST STE 200
REDWOOD CITY CA
94063-1759
US

IV. Provider business mailing address

369 MAIN ST STE 200
REDWOOD CITY CA
94063-1759
US

V. Phone/Fax

Practice location:
  • Phone: 650-216-6111
  • Fax: 650-216-9725
Mailing address:
  • Phone: 650-216-6111
  • Fax: 650-216-9725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberG579120
License Number StateCA

VIII. Authorized Official

Name: MRS. MCKENZIE WILBORN
Title or Position: MEDICAL BILLING MANAGER
Credential:
Phone: 714-751-8864