Provider Demographics
NPI:1265872873
Name:SASHA SALLOUM, MD, INC
Entity type:Organization
Organization Name:SASHA SALLOUM, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALLOUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:8585-227-9260
Mailing Address - Street 1:1250 CLEVELAND AVE
Mailing Address - Street 2:SUITE A209
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-7300
Mailing Address - Country:US
Mailing Address - Phone:858-227-9260
Mailing Address - Fax:858-408-3663
Practice Address - Street 1:1250 CLEVELAND AVE
Practice Address - Street 2:SUITE A209
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-7300
Practice Address - Country:US
Practice Address - Phone:858-227-9260
Practice Address - Fax:858-408-3663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty