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General NPI Number Information
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NPI Number | 1942442157
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Entity Type | Organization
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Legal Business Name | MARK D, ALLISON, MD, A PROFESSIONAL COMPANY
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Dates
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Enumeration Date | 04/02/2009
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Last Update Date | 03/30/2011
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Provider Practice Location Address
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Address Line | 4100 CENTRAL AVE 106
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City | RIVERSIDE
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State | CA
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Zip | 92506-2933
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Country | US
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Telephone | 951-788-8332
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Fax |
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Provider Business Mailing Address
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Address Line | 5810 NANCY RIDGE DR 100
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City | SAN DIEGO
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State | CA
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Zip | 92121-2834
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERTATIONS
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Name | KENNY HEINE
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Credential |
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Telephone | 858-625-2990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | A51300
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License Number State | CA
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