Healthcare Provider Details

I. General information

NPI: 1861781957
Provider Name (Legal Business Name): MR. NATHAN ALLEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2011
Last Update Date: 10/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1827 ATLANTA AVE STE D3
RIVERSIDE CA
92507-7418
US

IV. Provider business mailing address

769 W BLAINE ST STE A
RIVERSIDE CA
92507-3970
US

V. Phone/Fax

Practice location:
  • Phone: 951-955-8000
  • Fax:
Mailing address:
  • Phone: 951-358-5186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: