Provider Demographics
NPI:1336449685
Name:ALLIKAS, MARY (LPT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:ALLIKAS
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29196 AUBERRY RD
Mailing Address - Street 2:
Mailing Address - City:PRATHER
Mailing Address - State:CA
Mailing Address - Zip Code:93651
Mailing Address - Country:US
Mailing Address - Phone:805-400-9192
Mailing Address - Fax:
Practice Address - Street 1:29196 AUBERRY RD
Practice Address - Street 2:
Practice Address - City:PRATHER
Practice Address - State:CA
Practice Address - Zip Code:93651
Practice Address - Country:US
Practice Address - Phone:805-400-9192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31644167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician