Provider Demographics
NPI:1750319778
Name:ALESH, ISSA G (MD)
Entity Type:Individual
Prefix:
First Name:ISSA
Middle Name:G
Last Name:ALESH
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 1:399 E HIGHLAND AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-3808
Mailing Address - Country:US
Mailing Address - Phone:909-881-7400
Mailing Address - Fax:909-881-5217
Practice Address - Street 1:399 E HIGHLAND AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-3808
Practice Address - Country:US
Practice Address - Phone:909-881-7400
Practice Address - Fax:909-881-5217
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA128313207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
700H262220OtherBLUE CROSS-BLUE CROSS
IA081493OtherCOMMERCIAL-COMMERCIAL NUMBER
IA081493OtherCHAMPUS-CHAMPUS
700H262220OtherBLUE CROSS-BLUE CROSS
IA081493OtherCOMMERCIAL-COMMERCIAL NUMBER