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General NPI Number Information
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NPI Number | 1578672838
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Entity Type | Organization
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Legal Business Name | LIVE OAK ALLERGY & ASTHMA CLINIC; PA
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 07/06/2021
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Provider Practice Location Address
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Address Line | 11515 TOEPPERWEIN RD. #202
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City | LIVE OAK
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State | TX
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Zip | 78233-3166
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Country | US
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Telephone | 210-646-6978
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Fax | 210-646-6979
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Provider Business Mailing Address
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Address Line | 11515 TOEPPERWEIN RD. #202
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City | LIVE OAK
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State | TX
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Zip | 78233-3166
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Country | US
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Telephone | 210-646-6978
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Fax | 210-646-6979
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Authorized Official
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Title or Position | OWNER
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Name | DR. MIGUEL JUAN MARTINEZ JR.
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Credential | MD
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Telephone | 210-314-5805
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number | H0024
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License Number State | TX
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