Provider Demographics
NPI:1982951208
Name:ALLERGY AND ASTHMA CONSULTANTS
Entity Type:Organization
Organization Name:ALLERGY AND ASTHMA CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MCKENZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILBORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-751-8864
Mailing Address - Street 1:369 MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-1759
Mailing Address - Country:US
Mailing Address - Phone:650-216-6111
Mailing Address - Fax:650-216-9725
Practice Address - Street 1:369 MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1759
Practice Address - Country:US
Practice Address - Phone:650-216-6111
Practice Address - Fax:650-216-9725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG579120207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOG579120Medicare UPIN