Healthcare Provider Details

I. General information

NPI: 1154053007
Provider Name (Legal Business Name): PARTNERSHIP OF JOSEPH E ALLEN MD & RUSSELL B HAYS MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4116 W POINT LOMA BLVD
SAN DIEGO CA
92110-5605
US

IV. Provider business mailing address

4116 W POINT LOMA BLVD
SAN DIEGO CA
92110-5605
US

V. Phone/Fax

Practice location:
  • Phone: 619-225-1212
  • Fax: 619-225-1726
Mailing address:
  • Phone: 619-225-1212
  • Fax: 619-225-1726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH E ALLEN
Title or Position: PARTNER
Credential: MD
Phone: 619-225-1212