MEDICARE: DR. ALICIA REGINA WALLS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	P5755	TX
2	2080P0006X	Developmental - Behavioral Pediatrics Physician	P5755	TX

General Provider Information

NPI Number	:	1124373501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALICIA REGINA WALLS M.D.

Provider Business Mailing Address
First Line	:	14960 PARK ROW DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-5165
Country	:	US
Telephone Number	:	281-298-1144
Fax Number	:	281-297-1133

Provider Business Practice Location Address
First Line	:	17520 W GRAND PKWY S STE 120
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-4759
Country	:	US
Telephone Number	:	281-298-1144
Fax Number	:	281-298-1133

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2012
Last Update Date	:	08/30/2022

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Directions to “ DR. ALICIA REGINA WALLS M.D.” Practice Location

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