Provider Demographics
NPI:1699245225
Name:ALLEN, TENEIL ROSHANA
Entity type:Individual
Prefix:
First Name:TENEIL
Middle Name:ROSHANA
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TENEIL
Other - Middle Name:ROSHANA
Other - Last Name:MOSBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:369 N EUCALYPTUS AVE APT 33
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-6078
Mailing Address - Country:US
Mailing Address - Phone:909-640-4554
Mailing Address - Fax:
Practice Address - Street 1:369 N EUCALYPTUS AVE APT 33
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-6078
Practice Address - Country:US
Practice Address - Phone:909-640-4554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician