Healthcare Provider Details

I. General information

NPI: 1699076331
Provider Name (Legal Business Name): MONIKA A ALLEN ND, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2010
Last Update Date: 01/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 MAIN ST SUITE B
MORRO BAY CA
93442-2269
US

IV. Provider business mailing address

665 MAIN ST SUITE B
MORRO BAY CA
93442-2269
US

V. Phone/Fax

Practice location:
  • Phone: 805-771-8324
  • Fax: 805-771-8413
Mailing address:
  • Phone: 805-771-8324
  • Fax: 805-771-8413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND567
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC-15104
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: