Provider Demographics
NPI:1639917602
Name:ALLEN, JOSEPH ALEXANDER III
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ALEXANDER
Last Name:ALLEN
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4907 LINSCOTT PL APT 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-5455
Mailing Address - Country:US
Mailing Address - Phone:760-590-5930
Mailing Address - Fax:
Practice Address - Street 1:221 E BARCLAY ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-2217
Practice Address - Country:US
Practice Address - Phone:760-590-5630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-16
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty