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NPI Code Detail

MEDICARE: JEREMY ALAN ALLRED

MEDICARE: JEREMY ALAN 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
11041C0700XClinical Social Worker98939CA

General Provider Information

NPI Number : 1619344009
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEREMY ALAN ALLRED
Provider Business Mailing Address
First Line : 200 BROADWAY ST STE 70
Second Line :
City : KING CITY
State : CA
Zip : 93930-2866
Country : US
Telephone Number : 831-759-7280
Fax Number : 831-775-8144
Provider Business Practice Location Address
First Line : 200 BROADWAY ST STE 70
Second Line :
City : KING CITY
State : CA
Zip : 93930-2866
Country : US
Telephone Number : 831-759-7280
Fax Number : 831-775-8144
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2015
Last Update Date : 03/26/2026

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