Healthcare Provider Details

I. General information

NPI: 1437415593
Provider Name (Legal Business Name): BAYOU ALLERGY TESTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 SOUTHWEST FWY STE 510
HOUSTON TX
77027-7319
US

IV. Provider business mailing address

4140 SOUTHWEST FWY STE 510
HOUSTON TX
77027-7319
US

V. Phone/Fax

Practice location:
  • Phone: 713-621-2556
  • Fax: 713-621-2139
Mailing address:
  • Phone: 713-621-2556
  • Fax: 713-621-2139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QI0000X
TaxonomyImmunology Pathology Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: MAJED IBRAHIM
Title or Position: PRESIDENT
Credential:
Phone: 713-621-2556