Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 95015714 | CA |
NPI | 1033718580 |
---|---|
Provider Name | Mr. John Sylvanus Allieu SR. |
First Address | Los Banos, CA 93635-9473 |
Second Address | Los Banos, CA 93635-9473 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2020 |
Last Update Date | 25/10/2020 |