Healthcare Provider Details

I. General information

NPI: 1003320177
Provider Name (Legal Business Name): ALLIE GIFFEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2017
Last Update Date: 11/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 RUFFIN CT # B
SAN DIEGO CA
92123-5300
US

IV. Provider business mailing address

9400 RUFFIN CT # B
SAN DIEGO CA
92123-5300
US

V. Phone/Fax

Practice location:
  • Phone: 858-874-1082
  • Fax:
Mailing address:
  • Phone: 858-874-1082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95142335
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: