Healthcare Provider Details

I. General information

NPI: 1184580862
Provider Name (Legal Business Name): BRAD ALLEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: FALLON FELIZ

II. Dates (important events)

Enumeration Date: 12/26/2025
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

698 N LYNORA ST
TULARE CA
93274-2964
US

IV. Provider business mailing address

698 N LYNORA ST
TULARE CA
93274-2964
US

V. Phone/Fax

Practice location:
  • Phone: 559-605-8164
  • Fax:
Mailing address:
  • Phone: 559-605-8164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: