Provider Demographics
NPI:1174552533
Name:ADLER, MARK J
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:ADLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 SYCAMORE AVE
Mailing Address - Street 2:SUITE 270
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-7832
Mailing Address - Country:US
Mailing Address - Phone:760-598-1700
Mailing Address - Fax:760-598-1196
Practice Address - Street 1:910 SYCAMORE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-7832
Practice Address - Country:US
Practice Address - Phone:760-598-1700
Practice Address - Fax:760-598-1196
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG58922207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G589220Medicaid
CA5734915OtherGHI
CA830000207OtherRAILROAD MEDICARE
CA830000207OtherRAILROAD MEDICARE
CAWG58922AMedicare PIN
CA4112180001Medicare NSC