Healthcare Provider Details

I. General information

NPI: 1669834263
Provider Name (Legal Business Name): MRS. ALANA LEIGH WAIWAIOLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALANA LEIGH AMACK

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BODIN CIR
TRAVIS AFB CA
94535-1809
US

IV. Provider business mailing address

300 PASTEUR DR RM H3580
STANFORD CA
94305-2200
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-3000
  • Fax:
Mailing address:
  • Phone: 650-723-4000
  • 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 StateCA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA150656
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: