Provider Demographics
NPI:1184681710
Name:ALLEN, SCOTT ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ANDREW
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:26520 CACTUS AVE
Mailing Address - Street 2:FIRST FLOOR: ACCESS CLINIC
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555
Mailing Address - Country:US
Mailing Address - Phone:951-988-9929
Mailing Address - Fax:951-486-5482
Practice Address - Street 1:26520 CACTUS AVE
Practice Address - Street 2:FIRST FLOOR: ACCESS CLINIC
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555
Practice Address - Country:US
Practice Address - Phone:951-486-5573
Practice Address - Fax:951-486-5482
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD09243207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9020093Medicaid
RIF61717Medicare UPIN