Healthcare Provider Details

I. General information

NPI: 1619344009
Provider Name (Legal Business Name): JEREMY ALAN ALLRED
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2015
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BROADWAY ST STE 70
KING CITY CA
93930-2866
US

IV. Provider business mailing address

200 BROADWAY ST STE 70
KING CITY CA
93930-2866
US

V. Phone/Fax

Practice location:
  • Phone: 831-759-7280
  • Fax: 831-775-8144
Mailing address:
  • Phone: 831-759-7280
  • Fax: 831-775-8144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number98939
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: