Healthcare Provider Details

I. General information

NPI: 1992021091
Provider Name (Legal Business Name): ALLEN S TU PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2010
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 EMBARCADERO CTR LBBY LEVEL
SAN FRANCISCO CA
94111-3823
US

IV. Provider business mailing address

8564 SIENA CT
BLAINE WA
98230-6602
US

V. Phone/Fax

Practice location:
  • Phone: 415-578-3100
  • Fax: 415-252-7176
Mailing address:
  • Phone: 765-427-7775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA59493
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60135305
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: