Healthcare Provider Details

I. General information

NPI: 1477047835
Provider Name (Legal Business Name): DEBORAH KAY ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6939 MORNINGSIDE AVE
RIVERSIDE CA
92504
US

IV. Provider business mailing address

6939 MORNINGSIDE AVE
RIVERSIDE CA
92504-1946
US

V. Phone/Fax

Practice location:
  • Phone: 951-215-1390
  • Fax:
Mailing address:
  • Phone: 951-215-1390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: