Provider Demographics
NPI:1629658398
Name:SAMON, ALLISON J
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:J
Last Name:SAMON
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 1:1124 N SHERBOURNE DR APT 20
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-2236
Mailing Address - Country:US
Mailing Address - Phone:424-288-4545
Mailing Address - Fax:
Practice Address - Street 1:1124 N SHERBOURNE DR APT 20
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-2236
Practice Address - Country:US
Practice Address - Phone:424-288-4545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education