Provider Demographics
NPI:1942672456
Name:ORELLANA, ALLEN ZACHARY (CADC II, A050090718)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:ZACHARY
Last Name:ORELLANA
Suffix:
Gender:M
Credentials:CADC II, A050090718
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5626 SEXTON LN
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92509-6663
Mailing Address - Country:US
Mailing Address - Phone:951-214-3828
Mailing Address - Fax:
Practice Address - Street 1:250 S G ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410-3320
Practice Address - Country:US
Practice Address - Phone:951-214-3828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-22
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARADT-II RII05400715OtherCCAAP CERTIFIED DRUAG AND ALCOHOL COUNSELOR