Stacey Lynn Allen, MT

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

License

5378 Issued in CA

Practice address

950 Boardwalk
Ste. 304
San Marcos, CA 92078-2600

Phone

(760) 613-4363

NPI assigned

May 9, 2012

Last updated

May 9, 2012By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Medical Technician

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1336521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1336521600000",
    "number": "1780943886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 RUSH DR",
            "address_2": "#27",
            "city": "SAN MARCOS",
            "state": "CA",
            "postal_code": "920787950",
            "telephone_number": "760-613-4363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 BOARDWALK",
            "address_2": "STE. 304",
            "city": "SAN MARCOS",
            "state": "CA",
            "postal_code": "920782600",
            "telephone_number": "760-613-4363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALLEN",
        "first_name": "STACEY",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "credential": "MT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-05-09",
        "last_updated": "2012-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "CA",
            "license": "5378",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAMTC",
            "identifier": "5378",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ABMP",
            "identifier": "967160",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12363328",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Alexander, RCP, RRT
• Maria Alita
• Pouyan Allahyari
• Brittany Allen-Robertson
• Simone Valencia Allen
• Allred Dental Corporation
• Jeffrey Glen Allred, D.D.S.
• Joshua Almadin
• Alpha Physical Therapy and Performance, Inc
• Alta Vista Public Charter Inc. (Learn4Life)

• Community Health Worker in San Marcos, CA
• Providers in San Marcos, CA by specialty
• Community Health Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.