Provider Demographics
NPI:1215243092
Name:ALLOS, ZIAD (MD)
Entity type:Individual
Prefix:
First Name:ZIAD
Middle Name:
Last Name:ALLOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2054 CHARDON LN
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-3885
Mailing Address - Country:US
Mailing Address - Phone:619-990-9236
Mailing Address - Fax:
Practice Address - Street 1:10862 CALLE VERDE
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-7340
Practice Address - Country:US
Practice Address - Phone:619-670-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125058752390200000X
CAA124718207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL125058752OtherSTATE LICENSE
IL125058752OtherSTATE LICENSE