Provider Demographics
NPI:1225148356
Name:STRAUSS, JOHN HERMAN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:HERMAN
Last Name:STRAUSS
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 1:2918 5TH AVE
Mailing Address - Street 2:#100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-5910
Mailing Address - Country:US
Mailing Address - Phone:619-260-0134
Mailing Address - Fax:619-260-0119
Practice Address - Street 1:2918 5TH AVE
Practice Address - Street 2:#100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5910
Practice Address - Country:US
Practice Address - Phone:619-260-0134
Practice Address - Fax:619-260-0119
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG18471174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G184710Medicaid
CAG18471Medicare PIN
CAA40355Medicare UPIN