Healthcare Provider Details

I. General information

NPI: 1114479177
Provider Name (Legal Business Name): BLANCA ALLEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2016
Last Update Date: 09/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 S SAN PEDRO ST
LOS ANGELES CA
90011-2023
US

IV. Provider business mailing address

2801 S SAN PEDRO ST
LOS ANGELES CA
90011-2023
US

V. Phone/Fax

Practice location:
  • Phone: 323-233-3100
  • Fax: 323-233-4100
Mailing address:
  • Phone: 323-233-3100
  • Fax: 323-233-4100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number132232
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: