Provider Demographics
NPI:1427563410
Name:ALLEN, DESIRAE AMBER-KAY
Entity Type:Individual
Prefix:MRS
First Name:DESIRAE
Middle Name:AMBER-KAY
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8979 WEAVER CT
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-7234
Mailing Address - Country:US
Mailing Address - Phone:252-722-1128
Mailing Address - Fax:
Practice Address - Street 1:9057 SOQUEL DR
Practice Address - Street 2:BUILDING C, SUITE A
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003
Practice Address - Country:US
Practice Address - Phone:252-722-1128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker