Provider Demographics
NPI:1053420059
Name:ALLES, KATHLEEN A (DPM)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:ALLES
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:245 MOUNT HERMON RD
Mailing Address - Street 2:SUITE M8
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066-4035
Mailing Address - Country:US
Mailing Address - Phone:831-609-6096
Mailing Address - Fax:831-609-6417
Practice Address - Street 1:245 MOUNT HERMON RD
Practice Address - Street 2:SUITE M8
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-4035
Practice Address - Country:US
Practice Address - Phone:831-609-6096
Practice Address - Fax:831-609-6417
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3764213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABA0015210OtherRAILROAD MEDICARE
CAW19377Medicare UPIN
CA000E37640Medicare ID - Type UnspecifiedMEDICARE