Provider Demographics
NPI:1528199239
Name:ALLEN, ANTHONY ALEXANDER (C PED)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:ALEXANDER
Last Name:ALLEN
Suffix:
Gender:M
Credentials:C PED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18783 S AVENIDA RIO VELOZ
Mailing Address - Street 2:
Mailing Address - City:SAHUARITA
Mailing Address - State:AZ
Mailing Address - Zip Code:85629-8172
Mailing Address - Country:US
Mailing Address - Phone:520-304-1774
Mailing Address - Fax:
Practice Address - Street 1:230 W CONTINENTAL RD STE 416
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85622-3591
Practice Address - Country:US
Practice Address - Phone:520-399-1365
Practice Address - Fax:520-696-3338
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20011174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist