Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC10572 | CA |
NPI | 1154549897 |
---|---|
Provider Name | Dr. Milo Duane Allen |
First Address | Watsonville, CA 95076-4424 |
Second Address | Watsonville, CA 95076-4424 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00001 | ASH PLANS (01) | CA |
47198 | BLUIE CROSS (01) | CA |
94036 | BLUE SHIELD (01) | CA |
SDMED | DME (01) | CA |
SKCA0 | (05) | CA |
SRRGA | RAILROAD MEDICARE (01) | CA |