Provider Demographics
NPI:1821591686
Name:ROGOL, ALISSA MEGAN (MD, JD)
Entity Type:Individual
Prefix:DR
First Name:ALISSA
Middle Name:MEGAN
Last Name:ROGOL
Suffix:
Gender:F
Credentials:MD, JD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:401 QUARRY RD
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1419
Mailing Address - Country:US
Mailing Address - Phone:650-725-5591
Mailing Address - Fax:
Practice Address - Street 1:401 QUARRY RD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1419
Practice Address - Country:US
Practice Address - Phone:650-725-5591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-17
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1641312084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry