Provider Demographics
NPI:1124373501
Name:WALLS, ALICIA REGINA (MD)
Entity type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:REGINA
Last Name:WALLS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:14960 PARK ROW DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-5165
Mailing Address - Country:US
Mailing Address - Phone:281-298-1144
Mailing Address - Fax:281-297-1133
Practice Address - Street 1:17520 W GRAND PKWY S STE 120
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-4759
Practice Address - Country:US
Practice Address - Phone:281-298-1144
Practice Address - Fax:281-298-1133
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2022-08-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXP5755208000000X, 2080P0006X, 2080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics