Provider Demographics
NPI:1306919568
Name:ALIKPALA, AGNES (MD)
Entity type:Individual
Prefix:DR
First Name:AGNES
Middle Name:
Last Name:ALIKPALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 RHODE ISLAND ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-5182
Mailing Address - Country:US
Mailing Address - Phone:415-826-7575
Mailing Address - Fax:415-826-2772
Practice Address - Street 1:350 RHODE ISLAND ST
Practice Address - Street 2:200
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-5182
Practice Address - Country:US
Practice Address - Phone:415-826-7575
Practice Address - Fax:415-826-2772
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA313172080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A313170Medicaid
CAA31317OtherSTATE LICENSE
CAA31317OtherSTATE LICENSE