Provider Demographics
NPI:1174834790
Name:IWAOKA-SCOTT, ALLISON (MD, AM)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:
Last Name:IWAOKA-SCOTT
Suffix:
Gender:F
Credentials:MD, AM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SECFTC 100 BLANKEN AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94134
Mailing Address - Country:US
Mailing Address - Phone:415-330-5747
Mailing Address - Fax:415-330-9120
Practice Address - Street 1:100 BLANKEN AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94134-2407
Practice Address - Country:US
Practice Address - Phone:415-330-5747
Practice Address - Fax:415-330-9120
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X, 101YM0800X
CAA1151242084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry