Provider Demographics
NPI:1104155514
Name:ALLEN, SARAH J (LAC, DIPL OM)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:J
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LAC, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 ACACIA WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-1313
Mailing Address - Country:US
Mailing Address - Phone:831-334-0161
Mailing Address - Fax:
Practice Address - Street 1:3065 PORTER ST STE 105
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2231
Practice Address - Country:US
Practice Address - Phone:831-334-0161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-14
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13241171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist