Healthcare Provider Details

I. General information

NPI: 1578481073
Provider Name (Legal Business Name): DAMON M ALLEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24900 HIGHWAY 202
TEHACHAPI CA
93561-5558
US

IV. Provider business mailing address

332 N ALLEN ST
BANNING CA
92220-5832
US

V. Phone/Fax

Practice location:
  • Phone: 661-822-4402
  • Fax:
Mailing address:
  • Phone: 313-350-6380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: