# SOUTHERN CALIFORNIA ALLERGY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1730469974
- **Authorized official:** CANDICE KENNON (PRACTICE MGR)
- **Authorized official phone:** (512) 732-2774

## Contact information

- **Practice address:** 16542 VENTURA BLVD STE 400, ENCINO, CA 91436-5045
- **Practice address phone:** (818) 990-9155
- **Practice address fax:** (818) 990-9167
- **Mailing address:** 303 E MAIN ST, ROUND ROCK, TX 78664-5246
- **Mailing address phone:** (512) 732-2774

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207K00000X | Allergy & Immunology Physician | — | NULL | Yes |
| 207K00000X | Allergy & Immunology Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/19/2011
- **Last updated:** 07/18/2023