Provider Demographics
NPI:1003072786
Name:ALASIL, TAREK (MD)
Entity Type:Individual
Prefix:DR
First Name:TAREK
Middle Name:
Last Name:ALASIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E CALIFORNIA BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3205
Mailing Address - Country:US
Mailing Address - Phone:626-568-8838
Mailing Address - Fax:626-574-7188
Practice Address - Street 1:8616 LA TIJERA BLVD STE 404
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3950
Practice Address - Country:US
Practice Address - Phone:310-673-2020
Practice Address - Fax:310-469-5290
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA242108207R00000X
CAA108797207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1760541569OtherGROUP NPI
CABW463AMedicare UPIN
CA1760541569OtherGROUP NPI