Provider Demographics
NPI:1295000438
Name:ALESSA MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ALESSA MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/CEO
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WAKIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-514-8177
Mailing Address - Street 1:6302 PRINCEVILLE CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-5524
Mailing Address - Country:US
Mailing Address - Phone:714-514-8177
Mailing Address - Fax:714-960-7655
Practice Address - Street 1:6302 PRINCEVILLE CIR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-5524
Practice Address - Country:US
Practice Address - Phone:714-514-8177
Practice Address - Fax:714-960-7655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98851207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty