Provider Demographics
NPI:1578949889
Name:SASHA SALLOUM MD INC A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SASHA SALLOUM MD INC A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:SS VASCULAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER AND PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:SALLOUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-567-7007
Mailing Address - Street 1:1045 E PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4616
Mailing Address - Country:US
Mailing Address - Phone:619-567-7007
Mailing Address - Fax:619-567-7775
Practice Address - Street 1:336 OXFORD ST STE 104
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-3121
Practice Address - Country:US
Practice Address - Phone:619-567-3556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA893002085R0204X, 208600000X, 2086S0129X, 208G00000X
213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty