Healthcare Provider Details

I. General information

NPI: 1881463412
Provider Name (Legal Business Name): ANGIELYN TRAN GASAWAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2023
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 HOWARD ST
SAN FRANCISCO CA
94103-2638
US

IV. Provider business mailing address

1847 ALEXANDER WAY
BRENTWOOD CA
94513-5129
US

V. Phone/Fax

Practice location:
  • Phone: 925-660-5145
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: