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General NPI Number Information
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NPI Number | 1760722797
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Entity Type | Organization
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Legal Business Name | PEDIATRIC AND ALLERGY CLINIC OF AUSTIN, PA
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Dates
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Enumeration Date | 02/28/2013
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Last Update Date | 02/28/2013
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Provider Practice Location Address
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Address Line | 2500 W WILLIAM CANNON DR 204
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City | AUSTIN
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State | TX
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Zip | 78745-5257
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Country | US
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Telephone | 512-326-9500
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Fax | 512-326-9502
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Provider Business Mailing Address
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Address Line | 2500 W WILLIAM CANNON DR 204
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City | AUSTIN
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State | TX
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Zip | 78745-5257
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Country | US
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Telephone | 512-326-9500
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Fax | 512-326-9502
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Authorized Official
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Title or Position | PRESIDENT AND DIRECTOR
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Name | MRS. JURAIRAT MOLINA
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Credential | MD
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Telephone | 512-326-9500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | L2478
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 659074
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | L2478
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License Number State | TX
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