Healthcare Provider Details

I. General information

NPI: 1447372651
Provider Name (Legal Business Name): CHARLISA F ALLEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8485 E MCDONALD DR SUITE 322
SCOTTSDALE AZ
85250-6335
US

IV. Provider business mailing address

8485 E MCDONALD DR SUITE 322
SCOTTSDALE AZ
85250-6335
US

V. Phone/Fax

Practice location:
  • Phone: 480-483-6276
  • Fax: 480-368-7145
Mailing address:
  • Phone: 480-483-6276
  • Fax: 480-368-7145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number3361514
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: