MEDICARE: RICHARD L. FASSETT, M.D., INC. JOSEPH E. ALLEN, M.D., INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor	A774760	CA

General Provider Information

NPI Number	:	1184815292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD L. FASSETT, M.D., INC. JOSEPH E. ALLEN, M.D., INC.

Provider Business Mailing Address
First Line	:	4116 W POINT LOMA BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-5605
Country	:	US
Telephone Number	:	619-225-1212
Fax Number	:	619-225-1726

Provider Business Practice Location Address
First Line	:	4116 W POINT LOMA BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-5605
Country	:	US
Telephone Number	:	619-225-1212
Fax Number	:	619-225-1726

Authorized Official
Title or Position	:	PHYSICIAN/PARTNER
Name	:	JOSEPH E. ALLEN
Credential	:	M.D.
Telephone Number	:	619-225-1212

Provider Enumeration Date	:	08/05/2007
Last Update Date	:	11/19/2020

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