Healthcare Provider Details

I. General information

NPI: 1104155514
Provider Name (Legal Business Name): SARAH J ALLEN L.AC, DIPL. O.M
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2009
Last Update Date: 04/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3065 PORTER ST STE 105
SOQUEL CA
95073-2231
US

IV. Provider business mailing address

23 ACACIA WAY
SANTA CRUZ CA
95062-1313
US

V. Phone/Fax

Practice location:
  • Phone: 831-334-0161
  • Fax:
Mailing address:
  • Phone: 831-334-0161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC13241
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: