Provider Demographics
NPI:1053131045
Name:ALLEN, TRIXIE MOON (CYT)
Entity type:Individual
Prefix:
First Name:TRIXIE
Middle Name:MOON
Last Name:ALLEN
Suffix:
Gender:F
Credentials:CYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5363 N SHANDON PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85749-8348
Mailing Address - Country:US
Mailing Address - Phone:520-834-6663
Mailing Address - Fax:
Practice Address - Street 1:8505 E OCOTILLO DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85750-9670
Practice Address - Country:US
Practice Address - Phone:844-809-1067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach