Provider Demographics
NPI:1467877183
Name:TOM, ALLEN (NP)
Entity Type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:
Last Name:TOM
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18305 FLORWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-4826
Mailing Address - Country:US
Mailing Address - Phone:310-251-1538
Mailing Address - Fax:
Practice Address - Street 1:18305 FLORWOOD AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-4826
Practice Address - Country:US
Practice Address - Phone:310-251-1538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA792214363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily