Provider Demographics
NPI:1124285150
Name:ALLEN, MIYA E (MD)
Entity type:Individual
Prefix:
First Name:MIYA
Middle Name:E
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1010 NUT TREE RD
Mailing Address - Street 2:SUITE 100B
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-4172
Mailing Address - Country:US
Mailing Address - Phone:707-624-7947
Mailing Address - Fax:707-624-7998
Practice Address - Street 1:1010 NUT TREE RD
Practice Address - Street 2:SUITE 100B
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-4172
Practice Address - Country:US
Practice Address - Phone:707-624-7947
Practice Address - Fax:707-624-7998
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2022-02-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA105636207RE0101X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program