Provider Demographics
NPI:1760461206
Name:HOREISH, ADAM K (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:K
Last Name:HOREISH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4225 EXECUTIVE SQ STE 450
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-8411
Mailing Address - Country:US
Mailing Address - Phone:858-810-0000
Mailing Address - Fax:858-268-1911
Practice Address - Street 1:340 4TH AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-3813
Practice Address - Country:US
Practice Address - Phone:619-427-1144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56089207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA159459OtherNO. CALIFORNIA PTAN
CACB237085OtherSO. CALIFORNIA PTAN
AZ705048Medicaid
CACB237085OtherSO. CALIFORNIA PTAN
AZZ107526Medicare PIN