Provider Demographics
NPI:1447574231
Name:D'ALTAVILLA ENTERPRISES, PLLC
Entity Type:Organization
Organization Name:D'ALTAVILLA ENTERPRISES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CILENTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-532-7311
Mailing Address - Street 1:PO BOX 130837
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77393-0837
Mailing Address - Country:US
Mailing Address - Phone:713-532-7311
Mailing Address - Fax:
Practice Address - Street 1:18929 HIGHWAY 59 N
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4270
Practice Address - Country:US
Practice Address - Phone:713-532-7311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical