Healthcare Provider Details

I. General information

NPI: 1699802710
Provider Name (Legal Business Name): ALYSSA KATHRYN WARGALA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 02/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 NEVADA CITY HWY
GRASS VALLEY CA
95945-7702
US

IV. Provider business mailing address

12501 WANDERER RD
AUBURN CA
95602-8124
US

V. Phone/Fax

Practice location:
  • Phone: 530-274-5020
  • Fax: 530-274-6687
Mailing address:
  • Phone: 530-613-3725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA15236
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: