Healthcare Provider Details

I. General information

NPI: 1114071636
Provider Name (Legal Business Name): ANN ELIZABETH ALLEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 04/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DANIEL BURNHAM CT SUITE 365C
SAN FRANCISCO CA
94109-5455
US

IV. Provider business mailing address

1 DANIEL BURNHAM CT SUITE 365C
SAN FRANCISCO CA
94109-5455
US

V. Phone/Fax

Practice location:
  • Phone: 415-561-9923
  • Fax: 415-922-6344
Mailing address:
  • Phone: 415-561-9923
  • Fax: 415-922-6344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberG64529
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: