Provider Demographics
NPI:1003916792
Name:MIRES, ASHLEY E (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:E
Last Name:MIRES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2040 S SANTA CRUZ ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-6821
Mailing Address - Country:US
Mailing Address - Phone:714-577-2124
Mailing Address - Fax:714-577-2125
Practice Address - Street 1:1211 W LA PALMA AVE
Practice Address - Street 2:#207
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2815
Practice Address - Country:US
Practice Address - Phone:714-772-8282
Practice Address - Fax:714-772-6493
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88444207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A884440Medicaid
CAP00387158OtherMEDICARE RR
CA00A884440Medicaid
CAWA88444BMedicare PIN
CAWA88444AMedicare PIN
CAWA88444AMedicare PIN