Provider Demographics
NPI:1942936828
Name:ALLEN, MARC S
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:S
Last Name:ALLEN
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 1:2145 CUMBERLAND LOOP
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-4284
Mailing Address - Country:US
Mailing Address - Phone:916-899-5423
Mailing Address - Fax:916-269-5823
Practice Address - Street 1:1211 ADORA CIR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-4409
Practice Address - Country:US
Practice Address - Phone:916-743-4950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator