Healthcare Provider Details

I. General information

NPI: 1902820368
Provider Name (Legal Business Name): ALLERGY & ENT ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date: 07/21/2021
Reactivation Date: 09/02/2021

III. Provider practice location address

106 CIRCLE WAY
LAKE JACKSON TX
77566
US

IV. Provider business mailing address

450 GEARS ROAD SUITE 420B
HOUSTON TX
77067-4509
US

V. Phone/Fax

Practice location:
  • Phone: 979-297-6503
  • Fax: 979-297-7600
Mailing address:
  • Phone: 281-453-4204
  • Fax: 281-874-0212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: VERONICA HERNANDEZ
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 281-453-4204