Basic Information
| Provider Information | |||||||||
| NPI: | 1124373501 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALLS | ||||||||
| FirstName: | ALICIA | ||||||||
| MiddleName: | REGINA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14960 PARK ROW DR | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770845165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812981144 | ||||||||
| FaxNumber: | 2812971133 | ||||||||
| Practice Location | |||||||||
| Address1: | 17520 W GRAND PKWY S STE 120 | ||||||||
| Address2: | |||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774794759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812981144 | ||||||||
| FaxNumber: | 2812981133 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2012 | ||||||||
| LastUpdateDate: | 08/30/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | P5755 | TX | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0006X | P5755 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics | Developmental – Behavioral Pediatrics |
No ID Information.