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General NPI Number Information
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NPI Number | 1548803562
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Entity Type | Individual
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Provider Name | ALEXANDRA MAI TAMAYO TONG PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/22/2019
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 2500 MERCED ST
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City | SAN LEANDRO
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State | CA
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Zip | 94577-4201
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Country | US
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Telephone | 510-454-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 646 PASEO DEL RIO
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City | SAN LORENZO
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State | CA
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Zip | 94580-1512
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Country | US
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Telephone | 510-676-1078
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085.007310
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 58584
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License Number State | CA
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