Provider Demographics
NPI:1578672838
Name:LIVE OAK ALLERGY & ASTHMA CLINIC; PA
Entity Type:Organization
Organization Name:LIVE OAK ALLERGY & ASTHMA CLINIC; PA
Other - Org Name:RAIQUA S. ARASTU MD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:JUAN
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:210-314-5805
Mailing Address - Street 1:11515 TOEPPERWEIN RD.
Mailing Address - Street 2:#202
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3166
Mailing Address - Country:US
Mailing Address - Phone:210-646-6978
Mailing Address - Fax:210-646-6979
Practice Address - Street 1:11515 TOEPPERWEIN RD.
Practice Address - Street 2:#202
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3166
Practice Address - Country:US
Practice Address - Phone:210-646-6978
Practice Address - Fax:210-646-6979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0024207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175331101Medicaid
TX00812XMedicare ID - Type UnspecifiedGROUP
TX175331101Medicaid