Healthcare Provider Details

I. General information

NPI: 1053172809
Provider Name (Legal Business Name): ELISIA AKIKO SCOTT CCMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELISIA AKIKO CORTEZ CCMA

II. Dates (important events)

Enumeration Date: 01/18/2024
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 BUENA VISTA AVE W
SAN FRANCISCO CA
94117-4108
US

IV. Provider business mailing address

1563 MISSION ST
SAN FRANCISCO CA
94103-2543
US

V. Phone/Fax

Practice location:
  • Phone: 415-535-8587
  • Fax:
Mailing address:
  • Phone: 415-762-3700
  • Fax: 415-865-0119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: