Healthcare Provider Details

I. General information

NPI: 1063564847
Provider Name (Legal Business Name): VICKI ALLEN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 D ST RM 601
ANTIOCH CA
94509-2346
US

IV. Provider business mailing address

3919 ALMONDWOOD CT
CONCORD CA
94519-1114
US

V. Phone/Fax

Practice location:
  • Phone: 925-777-9550
  • Fax:
Mailing address:
  • Phone: 925-686-1171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number149761
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: