Healthcare Provider Details

I. General information

NPI: 1609022938
Provider Name (Legal Business Name): ALIREZA HALATI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

478 SOUTH ANAHEIM HILLS ROAD
ANAHEIM CA
92807
US

IV. Provider business mailing address

478 S ANAHEIM HILLS RD
ANAHEIM HILLS CA
92807-4760
US

V. Phone/Fax

Practice location:
  • Phone: 714-282-5437
  • Fax: 714-282-8724
Mailing address:
  • Phone: 714-282-5437
  • Fax: 714-282-8724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA92433
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: