Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A77476 | CA |
N | 207QS0010X | Family Doctor - Sports Medicine | A77476 | CA |
NPI | 1285720011 |
---|---|
Provider Name | Dr. Joseph Edward Allen |
First Address | San Diego, CA 92110-5605 |
Second Address | San Diego, CA 92110-5605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 19/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H74074 | (02) | CA |