Healthcare Provider Details

I. General information

NPI: 1962581074
Provider Name (Legal Business Name): ALI R LASHGARI MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 04/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

477 N EL CAMINO REAL SUITE A300
ENCINITAS CA
92024-1352
US

IV. Provider business mailing address

477 N EL CAMINO REAL SUITE A300
ENCINITAS CA
92024-1352
US

V. Phone/Fax

Practice location:
  • Phone: 760-436-8700
  • Fax: 760-436-8937
Mailing address:
  • Phone: 760-436-8700
  • Fax: 760-436-8937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. LISA MILLER
Title or Position: PATIENT ACCOUNTS MANAGER
Credential:
Phone: 760-787-0765