MEDICARE: ALLEN JOSEPH DUMOLIEN A.T.C.

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1649313529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLEN JOSEPH DUMOLIEN A.T.C.

Provider Business Mailing Address
First Line	:	5042 DUNBAR AVE APT C
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92649-4416
Country	:	US
Telephone Number	:	714-323-9533
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 BRISTOL ST N
Second Line	:	SUITE 25
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-8916
Country	:	US
Telephone Number	:	949-250-1112
Fax Number	:

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

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	05/11/2009

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