Healthcare Provider Details

I. General information

NPI: 1497944128
Provider Name (Legal Business Name): ALAN R NILI D O A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2007
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 ENDEAVOR SUITE 307
IRVINE CA
92618-3164
US

IV. Provider business mailing address

PO BOX 2795
SUISUN CITY CA
94585-5795
US

V. Phone/Fax

Practice location:
  • Phone: 949-260-0106
  • Fax: 949-260-0105
Mailing address:
  • Phone: 657-241-3600
  • Fax: 657-241-7708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberBN5296036
License Number StateCA

VIII. Authorized Official

Name: ALAN R. NILI
Title or Position: OWNER
Credential:
Phone: 949-260-0106