Provider Demographics
NPI:1770264996
Name:CIFUENTES, ALLEN A SR
Entity type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:A
Last Name:CIFUENTES
Suffix:SR
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 1:520 E FRESNO ST
Mailing Address - Street 2:
Mailing Address - City:DINUBA
Mailing Address - State:CA
Mailing Address - Zip Code:93618-1904
Mailing Address - Country:US
Mailing Address - Phone:559-754-6837
Mailing Address - Fax:
Practice Address - Street 1:520 E FRESNO ST
Practice Address - Street 2:
Practice Address - City:DINUBA
Practice Address - State:CA
Practice Address - Zip Code:93618-1904
Practice Address - Country:US
Practice Address - Phone:559-754-6837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2520432471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography