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NPI Code Detail

MEDICARE: NICOLE ALLRED

MEDICARE: NICOLE ALLRED
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1417542648
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE ALLRED
Provider Business Mailing Address
First Line : 315 CENTENNIAL WAY
Second Line :
City : TUSTIN
State : CA
Zip : 92780-3714
Country : US
Telephone Number : 949-250-1101
Fax Number : 949-250-1103
Provider Business Practice Location Address
First Line : 315 CENTENNIAL WAY
Second Line :
City : TUSTIN
State : CA
Zip : 92780-3714
Country : US
Telephone Number : 949-250-1101
Fax Number : 949-250-1103
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2021
Last Update Date : 03/09/2021

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Directions to “ NICOLE ALLRED ” Practice Location

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