Healthcare Provider Details

I. General information

NPI: 1760461206
Provider Name (Legal Business Name): ADAM K HOREISH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 4TH AVE SUITE 4
CHULA VISTA CA
91910-3813
US

IV. Provider business mailing address

4225 EXECUTIVE SQ STE 450
LA JOLLA CA
92037-8411
US

V. Phone/Fax

Practice location:
  • Phone: 619-427-1144
  • Fax:
Mailing address:
  • Phone: 858-810-0000
  • Fax: 858-268-1911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number56089
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: