Provider Demographics
NPI:1467563031
Name:SOUTHWEST ALLERGY AND ASTHMA ASSOCIATES
Entity Type:Organization
Organization Name:SOUTHWEST ALLERGY AND ASTHMA ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:VENZOR
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:915-592-6269
Mailing Address - Street 1:11410 VISTA DEL SOL DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-5331
Mailing Address - Country:US
Mailing Address - Phone:915-592-6269
Mailing Address - Fax:915-592-8847
Practice Address - Street 1:11410 VISTA DEL SOL
Practice Address - Street 2:SUITE A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-5319
Practice Address - Country:US
Practice Address - Phone:915-592-6269
Practice Address - Fax:915-592-8847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2994174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXJ2994OtherLICENSE
TXPA 03562OtherTONIA PA LICENSE
TX113348004Medicaid
TX00517UMedicare ID - Type UnspecifiedGROUP
TXF55282Medicare UPIN
TX166563001Medicaid