Healthcare Provider Details

I. General information

NPI: 1174834790
Provider Name (Legal Business Name): ALLISON IWAOKA-SCOTT MD, AM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 KEITH ST
SAN FRANCISCO CA
94124-3231
US

IV. Provider business mailing address

SOUTHEAST CHILD/FAMILY THERAPY CENTER 2401 KEITH ST
SAN FRANCISCO CA
94124
US

V. Phone/Fax

Practice location:
  • Phone: 628-271-6210
  • Fax: 628-754-8119
Mailing address:
  • Phone: 628-271-6210
  • Fax: 628-754-8119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA115124
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA115124
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: