Healthcare Provider Details

I. General information

NPI: 1285701102
Provider Name (Legal Business Name): DALLAS ALLERGY AND ASTHMA CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5499 GLEN LAKES DR #100
DALLAS TX
75231
US

IV. Provider business mailing address

5499 GLEN LAKES DR #100
DALLAS TX
75231
US

V. Phone/Fax

Practice location:
  • Phone: 214-691-1330
  • Fax: 214-691-6405
Mailing address:
  • Phone: 214-691-1330
  • Fax: 214-691-6405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberD6588, G6386
License Number StateTX

VIII. Authorized Official

Name: YVETTE CORDOVA
Title or Position: PRACTICE MANAGER
Credential:
Phone: 214-691-1330