Healthcare Provider Details

I. General information

NPI: 1801287016
Provider Name (Legal Business Name): DAVID ALLEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2015
Last Update Date: 04/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 LA VETA AVE
ENCINITAS CA
92024-2014
US

IV. Provider business mailing address

1740 S EL CAMINO REAL UNIT J101
ENCINITAS CA
92024-7907
US

V. Phone/Fax

Practice location:
  • Phone: 858-401-2856
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number12458
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: