Provider Demographics
NPI:1356579668
Name:ALLEY, RANDALL (BSC, CP)
Entity type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:
Last Name:ALLEY
Suffix:
Gender:M
Credentials:BSC, CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 HAMPSHIRE ROAD
Mailing Address - Street 2:SUITE S
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361
Mailing Address - Country:US
Mailing Address - Phone:800-775-2870
Mailing Address - Fax:800-775-2870
Practice Address - Street 1:850 HAMPSHIRE ROAD
Practice Address - Street 2:SUITE S
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361
Practice Address - Country:US
Practice Address - Phone:800-775-2870
Practice Address - Fax:800-775-2870
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist