Provider Demographics
NPI:1689002172
Name:PECK, ALLISON JOY (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:JOY
Last Name:PECK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:JOY
Other - Last Name:CONSTANTINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21603 E SLEEPY HOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-1452
Mailing Address - Country:US
Mailing Address - Phone:909-720-0185
Mailing Address - Fax:
Practice Address - Street 1:315 N 3RD AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-1905
Practice Address - Country:US
Practice Address - Phone:626-332-4543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23728363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily