Organization
SOUTHERN CALIFORNIA ALLERGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CANDICE KENNON (PRACTICE MGR)
(512) 732-2774
Entity
Organization
Contact information
Practice address
16542 VENTURA BLVD STE 400, ENCINO, CA 91436-5045
(818) 990-9155
(818) 990-9167
Mailing address
303 E MAIN ST, ROUND ROCK, TX 78664-5246
(512) 732-2774
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
—
—
Other
Enumeration date
08/19/2011
Last updated
07/18/2023
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