Provider Demographics
NPI:1154113777
Name:STARMAN, ALLYSON ROSE (MS LCGC)
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:ROSE
Last Name:STARMAN
Suffix:
Gender:F
Credentials:MS LCGC
Other - Prefix:
Other - First Name:ALLYSON
Other - Middle Name:ROSE
Other - Last Name:WALTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS LCGC
Mailing Address - Street 1:84 BENTLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-6003
Mailing Address - Country:US
Mailing Address - Phone:805-423-5235
Mailing Address - Fax:
Practice Address - Street 1:751 S BASCOM AVE STE 210
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2699
Practice Address - Country:US
Practice Address - Phone:408-793-2500
Practice Address - Fax:408-885-3225
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGC000539261QG0250X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QG0250XAmbulatory Health Care FacilitiesClinic/CenterGenetics