Healthcare Provider Details

I. General information

NPI: 1164261228
Provider Name (Legal Business Name): TIARA AJENE-GAIL ALLEN ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6060 SUNRISE VISTA DRIVE SUIT 2100
SACRAMENTO CA
95628
US

IV. Provider business mailing address

6060 SUNRISE VISTA DRIVE SUIT 2100
SA CA
95628
US

V. Phone/Fax

Practice location:
  • Phone: 916-967-6253
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW134505
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: