Provider Demographics
NPI:1578615720
Name:THEIS, ALISSA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:MARIE
Last Name:THEIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5400 W HILLSDALE AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-8222
Mailing Address - Country:US
Mailing Address - Phone:559-738-7500
Mailing Address - Fax:559-627-0106
Practice Address - Street 1:5400 W HILLSDALE AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-8222
Practice Address - Country:US
Practice Address - Phone:559-738-7500
Practice Address - Fax:559-627-0106
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA70181207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A701811Medicare PIN
CAH37895Medicare UPIN