Provider Demographics
NPI:1629075882
Name:RUSHOVICH, ALAN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:MICHAEL
Last Name:RUSHOVICH
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 1:15375 BARRANCA PKWY
Mailing Address - Street 2:STE H-105
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2209
Mailing Address - Country:US
Mailing Address - Phone:949-387-8111
Mailing Address - Fax:949-387-6163
Practice Address - Street 1:15375 BARRANCA PKWY
Practice Address - Street 2:STE H-105
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2209
Practice Address - Country:US
Practice Address - Phone:949-387-8111
Practice Address - Fax:949-387-6163
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-02
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42199174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A421990Medicaid
CAGR0057490Medicaid
CAA29525Medicare UPIN
CAGR0057490Medicaid