Healthcare Provider Details

I. General information

NPI: 1053134387
Provider Name (Legal Business Name): DAVID ALLEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2024
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E OCEAN BLVD UNIT 2504
LONG BEACH CA
90802-5039
US

IV. Provider business mailing address

700 E OCEAN BLVD UNIT 2504
LONG BEACH CA
90802-5039
US

V. Phone/Fax

Practice location:
  • Phone: 323-791-7640
  • Fax:
Mailing address:
  • Phone: 323-791-7640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95034527
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN95179650
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: