Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251H1200X | Hand | 10917 | CA |
NPI | 1356803423 |
---|---|
Provider Name | Jeanette Allison |
First Address | Santa Cruz, CA 95062-2096 |
Second Address | Santa Cruz, CA 95062-2096 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2019 |
Last Update Date | 05/04/2019 |