Healthcare Provider Details

I. General information

NPI: 1215276712
Provider Name (Legal Business Name): MICHELE ALLEN REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2013
Last Update Date: 04/26/2024
Certification Date: 04/24/2024
Deactivation Date: 07/06/2022
Reactivation Date: 04/24/2024

III. Provider practice location address

405 W 5TH STREET
SANTA ANA CA
92701-4599
US

IV. Provider business mailing address

405 W 5TH ST
SANTA ANA CA
92701-4599
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-3101
  • Fax:
Mailing address:
  • Phone: 714-834-3101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number36670
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN95255201
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: