Provider Demographics
NPI:1831202019
Name:CAMPBELL, ALLISON BROOKS (PA)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:BROOKS
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PORTER DR STE 215
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1524
Mailing Address - Country:US
Mailing Address - Phone:925-362-2166
Mailing Address - Fax:855-574-3055
Practice Address - Street 1:5801 NORRIS CANYON RD STE 210
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-5440
Practice Address - Country:US
Practice Address - Phone:925-355-7350
Practice Address - Fax:925-244-1457
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002910363AM0700X, 363AS0400X, 363AS0400X
CAPA14958363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S45935Medicare UPIN