Basic Information
| Provider Information | |||||||||
| NPI: | 1902566409 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALLDREDGE | ||||||||
| FirstName: | COLLEEN | ||||||||
| MiddleName: | BRIDGET | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13281 LAMPLITE LN | ||||||||
| Address2: | |||||||||
| City: | LAKESIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920405133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195992825 | ||||||||
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| Practice Location | |||||||||
| Address1: | 734 10TH AVE | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921016502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192394663 | ||||||||
| FaxNumber: | 6192393045 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2021 | ||||||||
| LastUpdateDate: | 03/16/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | 117536 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.