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General NPI Number Information
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NPI Number | 1265432579
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Entity Type | Organization
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Legal Business Name | 1ST ALLERGY & ASTHMA
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Dates
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Enumeration Date | 07/28/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2136 E 104TH AVE SUITE C
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City | THORNTON
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State | CO
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Zip | 80233-4313
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Country | US
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Telephone | 720-929-8300
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Fax | 720-929-8444
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Provider Business Mailing Address
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Address Line | 2136 E 104TH AVE SUITE C
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City | THORNTON
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State | CO
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Zip | 80233-4313
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Country | US
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Telephone | 720-929-8300
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Fax | 720-929-8444
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. BETTY L BLACKER
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Credential | LPN
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Telephone | 720-929-8300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0201X
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Taxonomy Name | Pediatric Allergy/Immunology Physician
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License Number | 32130
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License Number State | CO
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