Healthcare Provider Details

I. General information

NPI: 1700319118
Provider Name (Legal Business Name): ALICIA HERBISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE BAYLOR PLAZA BCM 320 DEPARTMENT OF PEDIATRICS
HOUSTON TX
77030
US

IV. Provider business mailing address

ONE BAYLOR PLAZA BCM 320 DEPARTMENT OF PEDIATRICS
HOUSTON TX
77030
US

V. Phone/Fax

Practice location:
  • Phone: 832-824-1170
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberS5651
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberS5651
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: