Doctor Name: | ALI HEIDARI |
NPI Number: | 1962516351 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.O. |
License Number: | 20A6946 |
Business Practice Address: | 843 E Foothill Blvd Upland, CA - 917864034 |
Business Phone Number: | 9099821002 |
Business Fax Number: | |
Mailing Address: | 1777 Atlanta Ave, G6 RIVERSIDE |
State: | CA |
Postal Code: | 925077417 |
Phone Number: | 9516828999 |
Fax Number: | 9516829019 |
NPI Enumeration Date: | 08/19/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 20A6946 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |