Provider Demographics
NPI:1699076331
Name:ALLEN, MONIKA A (ND, LAC)
Entity type:Individual
Prefix:
First Name:MONIKA
Middle Name:A
Last Name:ALLEN
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MORRO BAY
Mailing Address - State:CA
Mailing Address - Zip Code:93442-2269
Mailing Address - Country:US
Mailing Address - Phone:805-771-8324
Mailing Address - Fax:805-771-8413
Practice Address - Street 1:665 MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:MORRO BAY
Practice Address - State:CA
Practice Address - Zip Code:93442-2269
Practice Address - Country:US
Practice Address - Phone:805-771-8324
Practice Address - Fax:805-771-8413
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND567175F00000X
CAAC-15104171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist