Healthcare Provider Details

I. General information

NPI: 1316294135
Provider Name (Legal Business Name): ALLIE N ROBERT CNIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2012
Last Update Date: 08/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 EXCHANGE AVE
SCHERTZ TX
78154-2116
US

IV. Provider business mailing address

PO BOX 592442
SAN ANTONIO TX
78259-0172
US

V. Phone/Fax

Practice location:
  • Phone: 210-566-2333
  • Fax: 210-566-1330
Mailing address:
  • Phone: 210-566-2333
  • Fax: 210-566-1330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number2189
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: