Healthcare Provider Details

I. General information

NPI: 1629192091
Provider Name (Legal Business Name): ALSAY MEDICAL GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 EUCLID AVE SUITE A
SAN DIEGO CA
92115-4522
US

IV. Provider business mailing address

610 21ST ST
SANTA MONICA CA
90402-3036
US

V. Phone/Fax

Practice location:
  • Phone: 619-280-3200
  • Fax:
Mailing address:
  • Phone: 310-899-1525
  • Fax: 310-899-1525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberG23834
License Number StateCA

VIII. Authorized Official

Name: DR. JAMES WILLIAM EISENBERG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-899-1525