Provider Demographics
NPI:1245592245
Name:ALWA, ALLYN CANO (DOM, LAC)
Entity Type:Individual
Prefix:DR
First Name:ALLYN
Middle Name:CANO
Last Name:ALWA
Suffix:
Gender:F
Credentials:DOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9621 CAMPO RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-1226
Mailing Address - Country:US
Mailing Address - Phone:619-462-4400
Mailing Address - Fax:
Practice Address - Street 1:9621 CAMPO RD
Practice Address - Street 2:SUITE B
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-1226
Practice Address - Country:US
Practice Address - Phone:619-462-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 3204171100000X
HI860171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist