Alexandros Mihalis Reizian, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

64496 Issued in CA

Practice address

4711 Monroe Ave
San Diego, CA 92115-3202

Phone

(619) 284-1197

Fax

(619) 393-0182

NPI assigned

Aug 20, 2014

Last updated

Mar 17, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1408492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1053710517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4711 MONROE AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921153202",
            "telephone_number": "619-284-1197",
            "fax_number": "619-393-0182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4711 MONROE AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921153202",
            "telephone_number": "619-284-1197",
            "fax_number": "619-393-0182"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "711 Avocado Ave",
            "address_purpose": "LOCATION",
            "city": "El Cajon",
            "state": "CA",
            "postal_code": "920206401",
            "country_code": "US",
            "telephone_number": "619-440-7000",
            "fax_number": "619-440-6007",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "711 Avocado Ave",
            "address_purpose": "LOCATION",
            "city": "El Cajon",
            "state": "CA",
            "postal_code": "920206401",
            "country_code": "US",
            "telephone_number": "619-440-7000",
            "fax_number": "619-440-6007",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REIZIAN",
        "first_name": "ALEXANDROS",
        "middle_name": "MIHALIS",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-08-20",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "64496",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in San Diego, CA
• Providers in San Diego, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.