Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | G71411 | CA |
NPI | 1063523819 |
---|---|
Provider Name | Mr. Daniel Bradley Allen |
First Address | San Leandro, CA 94578-2625 |
Second Address | San Leandro, CA 94578-2625 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G714112 | (05) | CA |
F43900 | (02) |