Healthcare Provider Details

I. General information

NPI: 1518064641
Provider Name (Legal Business Name): ALYSSA A NASH GOELITZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 GENESEE AVENUE SUITE 850
LA JOLLA CA
92037
US

IV. Provider business mailing address

9850 GENESEE AVENUE SUITE 850
LA JOLLA CA
92037
US

V. Phone/Fax

Practice location:
  • Phone: 858-657-0267
  • Fax: 858-657-9485
Mailing address:
  • Phone: 858-657-0267
  • Fax: 858-657-9485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA97756
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: