Provider Demographics
NPI:1245496843
Name:GRACOM, ALISON LYNN (PA)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:LYNN
Last Name:GRACOM
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
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Mailing Address - Street 1:4902 IRVINE CENTER DR STE 103
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-3334
Mailing Address - Country:US
Mailing Address - Phone:949-861-4177
Mailing Address - Fax:949-861-4178
Practice Address - Street 1:4902 IRVINE CENTER DR STE 103
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-3334
Practice Address - Country:US
Practice Address - Phone:949-861-4177
Practice Address - Fax:949-861-4178
Is Sole Proprietor?:No
Enumeration Date:2008-08-03
Last Update Date:2022-02-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY010754363AM0700X
CAPA20929363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical