Provider Demographics
NPI:1659524163
Name:ALLERGY INSTITUTE OF SAN ANTONIO, P.A.
Entity Type:Organization
Organization Name:ALLERGY INSTITUTE OF SAN ANTONIO, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELISEO
Authorized Official - Middle Name:M
Authorized Official - Last Name:VILLALOBOS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:210-722-0607
Mailing Address - Street 1:27637 LEGACY WOODS
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78015-4976
Mailing Address - Country:US
Mailing Address - Phone:210-442-8891
Mailing Address - Fax:
Practice Address - Street 1:4456 LOCKHILL SELMA RD STE 103
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-3993
Practice Address - Country:US
Practice Address - Phone:210-455-2000
Practice Address - Fax:210-957-2227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207KA0200X
TXL2042261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1659524163OtherALLERGY INSTITUTE OF SAN ANTONIO
TX1760479935OtherELISEO M VILLALOBOS