Provider Demographics
NPI:1518064641
Name:NASH GOELITZ, ALYSSA A (MD)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:A
Last Name:NASH GOELITZ
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9850 GENESEE AVENUE SUITE 850
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037
Mailing Address - Country:US
Mailing Address - Phone:858-657-0267
Mailing Address - Fax:858-657-9485
Practice Address - Street 1:9850 GENESEE AVENUE SUITE 850
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037
Practice Address - Country:US
Practice Address - Phone:858-657-0267
Practice Address - Fax:858-657-9485
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2017-01-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA97756207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CB205477Medicare UPIN