MEDICARE: ALI SHOOSHTARI ALAVI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	A163793	CA
2	2084P0800X	Psychiatry Physician	A163793	CA

General Provider Information

NPI Number	:	1356856694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALI SHOOSHTARI ALAVI MD

Provider Business Mailing Address
First Line	:	5078 MANOR RIDGE LN
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-2896
Country	:	US
Telephone Number	:	949-562-4039
Fax Number	:	949-239-7799

Provider Business Practice Location Address
First Line	:	5078 MANOR RIDGE LN
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-2896
Country	:	US
Telephone Number	:	949-562-4039
Fax Number	:	949-239-7799

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2017
Last Update Date	:	08/15/2024

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