Provider Demographics
NPI:1144421918
Name:ELHUSSINY, ALIAA H
Entity Type:Individual
Prefix:DR
First Name:ALIAA
Middle Name:H
Last Name:ELHUSSINY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32523 CORTE ZARAGOZA
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-1248
Mailing Address - Country:US
Mailing Address - Phone:951-834-9750
Mailing Address - Fax:714-571-3560
Practice Address - Street 1:25155 MADISON AVE
Practice Address - Street 2:STE. #101
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-8974
Practice Address - Country:US
Practice Address - Phone:951-834-9750
Practice Address - Fax:951-834-9758
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55721122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD55721Medicaid