Provider Demographics
NPI:1619099710
Name:VALLEY ALLERGY&ASTHMA CENTER PLLC
Entity Type:Organization
Organization Name:VALLEY ALLERGY&ASTHMA CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MACIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-686-4824
Mailing Address - Street 1:2108 S M ST
Mailing Address - Street 2:STE1
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1555
Mailing Address - Country:US
Mailing Address - Phone:956-686-4824
Mailing Address - Fax:956-683-1014
Practice Address - Street 1:2108 S M ST
Practice Address - Street 2:STE1
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1555
Practice Address - Country:US
Practice Address - Phone:956-686-4824
Practice Address - Fax:956-683-1014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4546207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154591501Medicaid
TX00403UMedicare ID - Type Unspecified