Healthcare Provider Details

I. General information

NPI: 1750319778
Provider Name (Legal Business Name): ISSA G. ALESH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 E HIGHLAND AVE SUITE 307
SAN BERNARDINO CA
92404-3808
US

IV. Provider business mailing address

399 E HIGHLAND AVE SUITE 307
SAN BERNARDINO CA
92404-3808
US

V. Phone/Fax

Practice location:
  • Phone: 909-881-7400
  • Fax: 909-881-5217
Mailing address:
  • Phone: 909-881-7400
  • Fax: 909-881-5217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA128313
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA128313
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: