Basic Information
| Provider Information | |||||||||
| NPI: | 1770181257 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALLYSON WELLS MD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 353 ULTIMO AVE | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908143200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202067631 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5150 E PACIFIC COAST HWY STE 100 | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908043394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624907600 | ||||||||
| FaxNumber: | 5624907601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2020 | ||||||||
| LastUpdateDate: | 10/15/2020 | ||||||||
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| AuthorizedOfficialLastName: | WELLS | ||||||||
| AuthorizedOfficialFirstName: | ALLYSON | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7202067631 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 10/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0804X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
No ID Information.