Healthcare Provider Details

I. General information

NPI: 1487549119
Provider Name (Legal Business Name): KATHERINE M ALLEN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2025
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 CHALCEDONY ST
SAN DIEGO CA
92109-3214
US

IV. Provider business mailing address

1812 CHALCEDONY ST
SAN DIEGO CA
92109-3214
US

V. Phone/Fax

Practice location:
  • Phone: 610-509-3880
  • Fax:
Mailing address:
  • Phone: 610-509-3880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA66912
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: