Provider Demographics
NPI:1275778300
Name:VITAL ALLERGY AND ASTHMA CENTER
Entity Type:Organization
Organization Name:VITAL ALLERGY AND ASTHMA CENTER
Other - Org Name:CARLOS J VITAL MDPA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:VITAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-538-1240
Mailing Address - Street 1:1213 HERMANN DR STE 550
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7089
Mailing Address - Country:US
Mailing Address - Phone:713-820-6380
Mailing Address - Fax:713-538-1244
Practice Address - Street 1:1213 HERMANN DR STE 550
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7089
Practice Address - Country:US
Practice Address - Phone:713-820-6380
Practice Address - Fax:713-538-1244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2177207KA0200X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty