Provider Demographics
NPI:1205696325
Name:ALLEN, KIANA M
Entity type:Individual
Prefix:
First Name:KIANA
Middle Name:M
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 1:2350 OSBUN RD UNIT 51
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-4657
Mailing Address - Country:US
Mailing Address - Phone:909-329-6757
Mailing Address - Fax:
Practice Address - Street 1:6800 INDIANA AVE STE 170
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4266
Practice Address - Country:US
Practice Address - Phone:951-533-5263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician