Healthcare Provider Details

I. General information

NPI: 1417256801
Provider Name (Legal Business Name): LAUNA K ALLEN PTN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2011
Last Update Date: 03/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 MORENA BLVD
SAN DIEGO CA
92110-3703
US

IV. Provider business mailing address

PO BOX 721275
PINON HILLS CA
92372-1275
US

V. Phone/Fax

Practice location:
  • Phone: 619-275-8000
  • Fax:
Mailing address:
  • Phone: 760-868-6752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License NumberPT35899
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: