Provider Demographics
NPI:1962687566
Name:COLUMBIA ASTHMA & ALLERGY CLINIC
Entity Type:Organization
Organization Name:COLUMBIA ASTHMA & ALLERGY CLINIC
Other - Org Name:COLUMBIA ASTHMA AND ALLERGY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-940-0860
Mailing Address - Street 1:3448 MOWRY AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1422
Mailing Address - Country:US
Mailing Address - Phone:510-373-3000
Mailing Address - Fax:510-744-9959
Practice Address - Street 1:3448 MOWRY AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538
Practice Address - Country:US
Practice Address - Phone:510-373-3000
Practice Address - Fax:510-744-9959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040042261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA50D1045257OtherCLIA
WA50D1045257OtherCLIA