Healthcare Provider Details

I. General information

NPI: 1225009319
Provider Name (Legal Business Name): MELISSA BARBARA ALLEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2006
Last Update Date: 03/16/2020
Certification Date: 03/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3260 SACRAMENTO ST
BERKELEY CA
94702-2739
US

IV. Provider business mailing address

3260 SACRAMENTO ST
BERKELEY CA
94702-2739
US

V. Phone/Fax

Practice location:
  • Phone: 510-601-6060
  • Fax: 510-553-2166
Mailing address:
  • Phone: 510-601-6060
  • Fax: 510-553-2166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number10100
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN543489
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number10100
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN 543489
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: