Provider Demographics
NPI:1750488755
Name:STRIZAK, ALAN MARC (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:MARC
Last Name:STRIZAK
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 1:5256 S MISSION RD STE 703
Mailing Address - Street 2:
Mailing Address - City:BONSALL
Mailing Address - State:CA
Mailing Address - Zip Code:92003-3622
Mailing Address - Country:US
Mailing Address - Phone:949-582-5934
Mailing Address - Fax:949-582-5237
Practice Address - Street 1:26151 MARGUERITE PKWY
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-5277
Practice Address - Country:US
Practice Address - Phone:949-582-5934
Practice Address - Fax:949-495-3715
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39101207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000G391010OtherBLUE SHIELD
CA000G391010OtherBLUE SHIELD
CAA47703Medicare UPIN