Provider Demographics
NPI:1396968152
Name:WANG, ALISA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:2285 CORPORATE CIR
Mailing Address - Street 2:STE 200
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7759
Mailing Address - Country:US
Mailing Address - Phone:702-360-2763
Mailing Address - Fax:949-783-2880
Practice Address - Street 1:24541 PACIFIC PARK DR
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-3065
Practice Address - Country:US
Practice Address - Phone:949-831-3057
Practice Address - Fax:949-831-2515
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2022-06-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA18266363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant