Alicia K Allen

Individual provider Active NPI Other Specialist/Technologist · Petaluma, CA

NPI 1821855545 · NPPES record last updated Feb 28, 2024

Key facts

NPI
1821855545
Entity type
Individual (NPI type 1)
Primary specialty
Other Specialist/Technologist 246Z00000X
Practice address
160 Keller St
Petaluma, CA 94952-2900
Phone
(707) 953-6969
NPI assigned
Feb 28, 2024
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Other Specialist/Technologist
Group: 193400000X SINGLE SPECIALTY GROUP
246Z00000X Yes

Addresses

Primary practice location

160 Keller St
Petaluma, CA 94952-2900

Mailing address

425 Douglas St
Petaluma, CA 94952-2504
Phone (707) 953-6969

Other providers in Petaluma, CA

All providers in Petaluma, CA · Other Specialist/Technologist in California

Sources for this page

Verify at the official NPI Registry.