Provider Demographics
NPI:1760718670
Name:EDGARDO G. ALICAWAY, M. D., P. C.
Entity Type:Organization
Organization Name:EDGARDO G. ALICAWAY, M. D., P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDGARDO
Authorized Official - Middle Name:GENEBRALDO
Authorized Official - Last Name:ALICAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:650-756-2597
Mailing Address - Street 1:1800 SULLIVAN AVE
Mailing Address - Street 2:SUITE 508
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2228
Mailing Address - Country:US
Mailing Address - Phone:650-756-2597
Mailing Address - Fax:650-756-6371
Practice Address - Street 1:1800 SULLIVAN AVE
Practice Address - Street 2:SUITE 508
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2228
Practice Address - Country:US
Practice Address - Phone:650-756-2597
Practice Address - Fax:650-756-6371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA505002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty