Provider Demographics
NPI:1093065047
Name:CORPUS CHRISTI ALLERGY ASSOCIATES
Entity Type:Organization
Organization Name:CORPUS CHRISTI ALLERGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MGR
Authorized Official - Prefix:MS
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-732-2774
Mailing Address - Street 1:303 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-5246
Mailing Address - Country:US
Mailing Address - Phone:512-732-2774
Mailing Address - Fax:
Practice Address - Street 1:5402 S STAPLES ST
Practice Address - Street 2:STE 205
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4670
Practice Address - Country:US
Practice Address - Phone:361-882-3487
Practice Address - Fax:361-882-3811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty