Healthcare Provider Details

I. General information

NPI: 1871794719
Provider Name (Legal Business Name): ALI VARZGAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 DOLBEER ST
EUREKA CA
95501-4736
US

IV. Provider business mailing address

658 O ST
FORTUNA CA
95540-1827
US

V. Phone/Fax

Practice location:
  • Phone: 707-269-4250
  • Fax:
Mailing address:
  • Phone: 424-216-0902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA92846
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: