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: 09/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BLANKEN AVE
SAN FRANCISCO CA
94134-2407
US

IV. Provider business mailing address

SECFTC 100 BLANKEN AVENUE
SAN FRANCISCO CA
94134
US

V. Phone/Fax

Practice location:
  • Phone: 415-330-5747
  • Fax: 415-330-9120
Mailing address:
  • Phone: 415-330-5747
  • Fax: 415-330-9120

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 TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA115124
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA115124
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: