Provider Demographics
NPI:1821345885
Name:ALLURED, JESSE RYAN
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:RYAN
Last Name:ALLURED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 FUNNY CIDE ST APT 103
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-2053
Mailing Address - Country:US
Mailing Address - Phone:707-253-4341
Mailing Address - Fax:707-299-4387
Practice Address - Street 1:2344 OLD SONOMA RD BLDG G
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-3708
Practice Address - Country:US
Practice Address - Phone:707-253-4341
Practice Address - Fax:707-299-4387
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAP18051146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic