Basic Information
| Provider Information | |||||||||
| NPI: | 1891339644 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ATTIGO INFUSION INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15301 SPECTRUM DR STE 330 | ||||||||
| Address2: | |||||||||
| City: | ADDISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750016462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9726612273 | ||||||||
| FaxNumber: | 9724211899 | ||||||||
| Practice Location | |||||||||
| Address1: | 15301 SPECTRUM DR STE 330 | ||||||||
| Address2: | |||||||||
| City: | ADDISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750016462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9726612273 | ||||||||
| FaxNumber: | 9724211899 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2019 | ||||||||
| LastUpdateDate: | 12/11/2020 | ||||||||
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| AuthorizedOfficialLastName: | DE AVILLEZ | ||||||||
| AuthorizedOfficialFirstName: | GUSTAVO | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9726612273 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.