Healthcare Provider Details

I. General information

NPI: 1124625843
Provider Name (Legal Business Name): ASTHMA & ALLERGY ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 COLORADO AVE
PUEBLO CO
81004-2075
US

IV. Provider business mailing address

2709 N TEJON ST
COLORADO SPGS CO
80907-6231
US

V. Phone/Fax

Practice location:
  • Phone: 719-564-2503
  • Fax: 719-630-3658
Mailing address:
  • Phone: 719-473-0872
  • Fax: 719-630-3658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALEJANDRA SPAULDING
Title or Position: PATIENT ACCOUNTS COORDINATOR
Credential:
Phone: 719-473-1800