MEDICARE: CITRUS PSYCHIATRIC MEDICAL CLINIC, INC.

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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1861419772
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITRUS PSYCHIATRIC MEDICAL CLINIC, INC.

Provider Business Mailing Address
First Line	:	500 W BADILLO ST
Second Line	:
City	:	COVINA
State	:	CA
Zip	:	91722-3762
Country	:	US
Telephone Number	:	626-859-2686
Fax Number	:	626-859-2685

Provider Business Practice Location Address
First Line	:	500 W BADILLO ST
Second Line	:
City	:	COVINA
State	:	CA
Zip	:	91722-3762
Country	:	US
Telephone Number	:	626-859-2686
Fax Number	:	626-859-2685

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SAJID ALI
Credential	:	M.D.
Telephone Number	:	626-859-2686

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	10/13/2008

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