1134694458 NPI number — DR. ALIREZA ALIBANAEI PHARMACIST

Table of content: DR. ALIREZA ALIBANAEI PHARMACIST (NPI 1134694458)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134694458 NPI number — DR. ALIREZA ALIBANAEI PHARMACIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALIBANAEI
Provider First Name:
ALIREZA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMACIST
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134694458
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 701
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODLAND HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91365-0701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-634-4198
Provider Business Mailing Address Fax Number:
818-436-0518

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
552 SESPE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FILLMORE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93015-1957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-242-4575
Provider Business Practice Location Address Fax Number:
818-436-0518
Provider Enumeration Date:
10/13/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  53427 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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