Healthcare Provider Details

I. General information

NPI: 1700435864
Provider Name (Legal Business Name): MR. ALLAN BENJAMIN MOLINA JAMISON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 S WHITE RD STE 200
SAN JOSE CA
95148-2079
US

IV. Provider business mailing address

2680 S WHITE RD STE 200
SAN JOSE CA
95148-2079
US

V. Phone/Fax

Practice location:
  • Phone: 408-274-0888
  • Fax: 408-274-2858
Mailing address:
  • Phone: 408-274-0888
  • Fax: 408-274-2858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number301579
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: