Provider Demographics
NPI: | 1942371794 |
---|---|
Name: | HAYEK, ALBERTO (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | ALBERTO |
Middle Name: | |
Last Name: | HAYEK |
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: | 3860 CALLE FORTUNADA |
Mailing Address - Street 2: | SUITE 210 |
Mailing Address - City: | SAN DIEGO |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92123-4800 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 858-309-6303 |
Mailing Address - Fax: | 858-309-6301 |
Practice Address - Street 1: | 8110 BIRMINGHAM WAY |
Practice Address - Street 2: | |
Practice Address - City: | SAN DIEGO |
Practice Address - State: | CA |
Practice Address - Zip Code: | 92123-2758 |
Practice Address - Country: | US |
Practice Address - Phone: | 858-966-4032 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-11-13 |
Last Update Date: | 2007-07-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | A26609 | 208000000X, 2080P0205X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Not Answered | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | |
Not Answered | 2080P0205X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | 00A266090 | Medicaid | |
CA | 00A266090 | Medicaid | |
CA | WA26609C | Medicare ID - Type Unspecified |