Provider Demographics
NPI:1447312947
Name:FAMILY ALLERGY & ASTHMA CONSULTANTS
Entity type:Organization
Organization Name:FAMILY ALLERGY & ASTHMA CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANCO
Authorized Official - Prefix:
Authorized Official - First Name:LALLAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLEGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-636-9100
Mailing Address - Street 1:4123 UNIVERSITY BLVD S
Mailing Address - Street 2:SUITE B
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4371
Mailing Address - Country:US
Mailing Address - Phone:904-636-9102
Mailing Address - Fax:904-636-9102
Practice Address - Street 1:4123 UNIVERSITY BLVD S
Practice Address - Street 2:SUITE B
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4371
Practice Address - Country:US
Practice Address - Phone:904-636-9102
Practice Address - Fax:904-636-9102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AG327OtherMEDICARE PTAN