Provider Demographics
NPI:1275658957
Name:JOHN W. ALLEN, M.D.
Entity Type:Organization
Organization Name:JOHN W. ALLEN, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-994-6527
Mailing Address - Street 1:11238 QUAIL CANYON RD
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-2254
Mailing Address - Country:US
Mailing Address - Phone:619-994-6527
Mailing Address - Fax:
Practice Address - Street 1:7200 PARKWAY DR STE 113
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-1534
Practice Address - Country:US
Practice Address - Phone:619-337-0455
Practice Address - Fax:619-667-6059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC377062084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W19387Medicare ID - Type Unspecified