Provider Demographics
NPI:1437760766
Name:ALLEN-SMITH, JERI LYN
Entity Type:Individual
Prefix:
First Name:JERI
Middle Name:LYN
Last Name:ALLEN-SMITH
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 1:9228 ALLANO WAY
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-2202
Mailing Address - Country:US
Mailing Address - Phone:619-876-8011
Mailing Address - Fax:
Practice Address - Street 1:9228 ALLANO WAY
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-2202
Practice Address - Country:US
Practice Address - Phone:619-876-8009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider