Healthcare Provider Details

I. General information

NPI: 1316585946
Provider Name (Legal Business Name): AALEEIA ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2019
Last Update Date: 12/02/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8912 VOLUNTEER LN
SACRAMENTO CA
95826-3221
US

IV. Provider business mailing address

1050 FULTON AVE STE 230
SACRAMENTO CA
95825-4299
US

V. Phone/Fax

Practice location:
  • Phone: 916-215-7940
  • Fax:
Mailing address:
  • Phone: 916-518-3187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: