Healthcare Provider Details

I. General information

NPI: 1356312011
Provider Name (Legal Business Name): PEDRO AVILA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 12/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20631 KUYKENDAHL RD SUITE 100
SPRING TX
77379-3318
US

IV. Provider business mailing address

20631 KUYKENDAHL RD SUITE 100
SPRING TX
77379-3318
US

V. Phone/Fax

Practice location:
  • Phone: 281-453-1001
  • Fax: 281-803-5515
Mailing address:
  • Phone: 281-453-1001
  • Fax: 281-803-5515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number036114428
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberQ6305
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: