MEDICARE: MS. DIANA M. ALLEN PA-C

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	363AS0400X	Surgical Physician Assistant	3671	AZ
2	363A00000X	Physician Assistant	3671	AZ

General Provider Information

NPI Number	:	1942497938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DIANA M. ALLEN PA-C

Provider Business Mailing Address
First Line	:	1609 N WARREN AVE STE 110
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85719-3761
Country	:	US
Telephone Number	:	520-626-4024
Fax Number	:	520-694-2668

Provider Business Practice Location Address
First Line	:	1609 N WARREN AVE STE 110
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85719-3761
Country	:	US
Telephone Number	:	520-626-4024
Fax Number	:	520-694-2668

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2007
Last Update Date	:	08/04/2020

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