Provider Demographics
NPI:1760941850
Name:RUNCO, ALYSSA GRACE
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:GRACE
Last Name:RUNCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:GRACE
Other - Last Name:DOMINGUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1 BAYLOR PLZ # BCM320
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3411
Mailing Address - Country:US
Mailing Address - Phone:832-824-1170
Mailing Address - Fax:832-825-9302
Practice Address - Street 1:1 BAYLOR PLZ # BCM320
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3411
Practice Address - Country:US
Practice Address - Phone:832-824-1170
Practice Address - Fax:832-825-9302
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ734872084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology