Healthcare Provider Details

I. General information

NPI: 1366776247
Provider Name (Legal Business Name): ALI JAMES BAGHAI CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 09/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15210 N 44TH PL
PHOENIX AZ
85032-4872
US

IV. Provider business mailing address

15210 N 44TH PL
PHOENIX AZ
85032-4872
US

V. Phone/Fax

Practice location:
  • Phone: 480-212-6025
  • Fax: 602-569-1453
Mailing address:
  • Phone: 480-212-6025
  • Fax: 602-569-1453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number136859
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: