Provider Demographics
NPI:1043553381
Name:ALLEYNE, JOSEPHUS GOMAR III
Entity Type:Individual
Prefix:MR
First Name:JOSEPHUS
Middle Name:GOMAR
Last Name:ALLEYNE
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2159 E COLUNGA ST
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-7509
Mailing Address - Country:US
Mailing Address - Phone:760-518-3346
Mailing Address - Fax:
Practice Address - Street 1:2159 E COLUNGA ST
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-7509
Practice Address - Country:US
Practice Address - Phone:760-518-3346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman