1508936592 NPI number — DR. ALI S ALAVI M.D.

Table of content: DR. ALI S ALAVI M.D. (NPI 1508936592)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508936592 NPI number — DR. ALI S ALAVI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALAVI
Provider First Name:
ALI
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1508936592
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1950 SUNNYCREST DR
Provider Second Line Business Mailing Address:
#3400
Provider Business Mailing Address City Name:
FULLERTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92835-3638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-879-2410
Provider Business Mailing Address Fax Number:
714-879-5340

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1950 SUNNYCREST DR
Provider Second Line Business Practice Location Address:
#3400
Provider Business Practice Location Address City Name:
FULLERTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92835-3638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-879-2410
Provider Business Practice Location Address Fax Number:
714-879-5340
Provider Enumeration Date:
11/08/2006

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: 208800000X , with the licence number:  35.151394 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X , with the licence number: 122109 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X , with the licence number: A79874 , 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)

  • Identifier: 1851498133 . This is a "GROUP NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 05D0684380 . This is a "CLIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 05D0977537 . This is a "CLIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: A79874 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR0011581 . This is a "MEDI-CAL GROUP NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 05D0552498 . This is a "CLIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 208800000X . This is a "TAXONOMY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: YYY49655Y . This is a "BLUE SHEILD GRP NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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