MEDICARE: PATRICIA LYNN ALLEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	G71645	CA

General Provider Information

NPI Number	:	1124052600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA LYNN ALLEN MD

Provider Business Mailing Address
First Line	:	1129 S SAN GABRIEL BLVD
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-3114
Country	:	US
Telephone Number	:	626-282-2802
Fax Number	:	626-282-2202

Provider Business Practice Location Address
First Line	:	1129 S SAN GABRIEL BLVD
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-3114
Country	:	US
Telephone Number	:	626-287-6746
Fax Number	:	626-827-8357

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	07/08/2007

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