Healthcare Provider Details

I. General information

NPI: 1902719149
Provider Name (Legal Business Name): HENA ALI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 CESENA WAY
FONTANA CA
92336-0268
US

IV. Provider business mailing address

5310 CESENA WAY
FONTANA CA
92336-0268
US

V. Phone/Fax

Practice location:
  • Phone: 619-746-5220
  • Fax:
Mailing address:
  • Phone: 619-746-5220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number95142317
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: