Provider Demographics
NPI:1609944297
Name:JOHNSON-ALVIZA, JACALYN N (MS, PA-C)
Entity Type:Individual
Prefix:
First Name:JACALYN
Middle Name:N
Last Name:JOHNSON-ALVIZA
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 HOLCOMBE BLVD
Mailing Address - Street 2:UNIT 1258
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4004
Mailing Address - Country:US
Mailing Address - Phone:713-563-8500
Mailing Address - Fax:713-563-8501
Practice Address - Street 1:1220 HOLCOMBE BLVD
Practice Address - Street 2:UNIT 1258
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4004
Practice Address - Country:US
Practice Address - Phone:713-563-8500
Practice Address - Fax:713-563-8501
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05001363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA05001OtherPA LICENSE