Provider Demographics
NPI:1881012417
Name:BAHORICH, ALYSSA (MD)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:BAHORICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11606 OAK GLEN CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-5147
Mailing Address - Country:US
Mailing Address - Phone:817-903-5407
Mailing Address - Fax:
Practice Address - Street 1:10420 LOUETTA RD STE 104
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-2194
Practice Address - Country:US
Practice Address - Phone:281-251-0269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR2526208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics