Provider Demographics
NPI:1114179454
Name:ALLRED, JAMES TIMOTHY JR (OPA-C)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:TIMOTHY
Last Name:ALLRED
Suffix:JR
Gender:M
Credentials:OPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N MOUNTAIN AVENUE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-5182
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 N MOUNTAIN AVENUE
Practice Address - Street 2:SUITE 310
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-5182
Practice Address - Country:US
Practice Address - Phone:909-920-0876
Practice Address - Fax:909-946-4926
Is Sole Proprietor?:No
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1059363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant