Healthcare Provider Details

I. General information

NPI: 1881781334
Provider Name (Legal Business Name): EDWARD CLARK ALLEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 10/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2190 CARMEL VALLEY RD B
DEL MAR CA
92014-3772
US

IV. Provider business mailing address

2190 CARMEL VALLEY RD B
DEL MAR CA
92014-3772
US

V. Phone/Fax

Practice location:
  • Phone: 858-877-9804
  • Fax: 858-724-1820
Mailing address:
  • Phone: 858-877-9804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA48040
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberA48040
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: