Provider Demographics
NPI:1780007302
Name:ALLEN, KAMRON
Entity Type:Individual
Prefix:
First Name:KAMRON
Middle Name:
Last Name:ALLEN
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:PO BOX 417
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93902-0417
Mailing Address - Country:US
Mailing Address - Phone:831-758-2746
Mailing Address - Fax:831-758-3834
Practice Address - Street 1:242 E ROMIE LN
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3128
Practice Address - Country:US
Practice Address - Phone:831-758-2746
Practice Address - Fax:831-758-3834
Is Sole Proprietor?:No
Enumeration Date:2014-02-03
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51272363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical