Provider Demographics
NPI:1255379582
Name:STREELMAN, ALLEN JAMES (DO)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:JAMES
Last Name:STREELMAN
Suffix:
Gender:M
Credentials:DO
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 275
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90702-0275
Mailing Address - Country:US
Mailing Address - Phone:562-282-4038
Mailing Address - Fax:562-977-4220
Practice Address - Street 1:9040 TELEGRAPH RD STE 102
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-2395
Practice Address - Country:US
Practice Address - Phone:562-861-0954
Practice Address - Fax:562-231-1906
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A3863207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
020A38630OtherBLUE SHIELD ID #
035425OtherHEALTH NET ID #
CA00AX38630Medicaid
010052829OtherRAILROAD
CA00AX38630Medicaid
E04684Medicare UPIN
010052829OtherRAILROAD