Healthcare Provider Details

I. General information

NPI: 1073193496
Provider Name (Legal Business Name): ALEXA MAE ALICANTE SANGALANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 06/07/2025
Certification Date: 06/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 PARNASSUS AVE
SAN FRANCISCO CA
94143-2206
US

IV. Provider business mailing address

185 S ORANGE AVE BLDG ROOMI506
NEWARK NJ
07103-2757
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-9035
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA181739
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: