Provider Demographics
NPI:1275853343
Name:ACUTE ALLERGY ASTHMA AND IMMUNOLOGY OF ATHERTON, INC.
Entity Type:Organization
Organization Name:ACUTE ALLERGY ASTHMA AND IMMUNOLOGY OF ATHERTON, INC.
Other - Org Name:ATHERTON ALLERGISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANJUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:DIXIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-814-2423
Mailing Address - Street 1:3301 EL CAMINO REAL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ATHERTON
Mailing Address - State:CA
Mailing Address - Zip Code:94027-3812
Mailing Address - Country:US
Mailing Address - Phone:650-556-9577
Mailing Address - Fax:650-556-0655
Practice Address - Street 1:3301 EL CAMINO REAL
Practice Address - Street 2:SUITE 101
Practice Address - City:ATHERTON
Practice Address - State:CA
Practice Address - Zip Code:94027-3812
Practice Address - Country:US
Practice Address - Phone:650-559-9577
Practice Address - Fax:650-556-0655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG84174207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty