Healthcare Provider Details

I. General information

NPI: 1093098626
Provider Name (Legal Business Name): ALLYSON FRITZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 05/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 SAN LEANDRO BLVD STE 300
SAN LEANDRO CA
94577-1675
US

IV. Provider business mailing address

1000 SAN LEANDRO BLVD STE 300
SAN LEANDRO CA
94577-1675
US

V. Phone/Fax

Practice location:
  • Phone: 501-618-3452
  • Fax:
Mailing address:
  • Phone: 501-618-3452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2470A2800X
TaxonomyAssistant Health Information Record Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: