Provider Demographics
NPI:1053633099
Name:ALLEN, MELANIE (CDE)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 LOS PALOS DR
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3916
Mailing Address - Country:US
Mailing Address - Phone:831-755-1717
Mailing Address - Fax:831-783-3115
Practice Address - Street 1:1033 LOS PALOS DR
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3916
Practice Address - Country:US
Practice Address - Phone:831-755-1717
Practice Address - Fax:831-783-3115
Is Sole Proprietor?:No
Enumeration Date:2010-02-18
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA720880133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA682908OtherREGISTERED NURSE
CA720880OtherCERTIFIED DIABETIC EDUCATOR