Provider Demographics
NPI:1245365444
Name:HIDEG, ALISA M L (MD)
Entity type:Individual
Prefix:DR
First Name:ALISA
Middle Name:M L
Last Name:HIDEG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6860 AVENIDA ENCINAS
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-3201
Mailing Address - Country:US
Mailing Address - Phone:760-931-6454
Mailing Address - Fax:760-931-4244
Practice Address - Street 1:6860 AVENIDA ENCINAS
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-3201
Practice Address - Country:US
Practice Address - Phone:760-931-6454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC-141123207Q00000X
WAMD00035508208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8227654Medicaid
WA8227654Medicaid
WAP00168453Medicare PIN
WAG8858117Medicare PIN
WAG8806307Medicare PIN