=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538452024
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAKE HOUSTON ASTHMA ALLERGY IMMUNOLOGY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2011
-----------------------------------------------------
Last Update Date | 05/17/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5514 ATASCOCITA RD
-----------------------------------------------------
City | HUMBLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77346-2968
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-825-2561
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2311 RIVER VILLAGE DR
-----------------------------------------------------
City | KINGWOOD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77339-1835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-825-2561
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROVIDER
-----------------------------------------------------
Name | JAVIER CHINEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 281-825-2561
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | M8597
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------